COMMON DISEASES 



COMMON DISEASES 



BY 



WOODS HUTCHINSON, A.M., M.D. 

Author of " Studies in Human and Comparative Pathology " 

"Instinct and Health,'''' " Preventable Diseases," 

"Handbook of Health," " We and 

Our Children," etc. 




RMW»ftffl£8 



BOSTON AND NEW YORK 

HOUGHTON MIFFLIN COMPANY 

(Cbe fttoer?ibe preg? <£ambri&0e 

1913 






COPYRIGHT, 1907, 1905, I909, I91O, AND I912, BY THE CURTIS 

PUBLISHING COMPANY 

COPYRIGHT, 1909 AND I9IO, BY THE FRANK A. MUNSEY COMPANY 

COPYRIGHT, 191 2, BY GOOD HOUSEKEEPING MAGAZINE 

COPYRIGHT, I913, BY WOODS HUTCHINSON 

ALL RIGHTS RESERVED 



Published March 1Q13 



LC Control Number 




tmp96 028698 



-o 



©CLA343443 







CONTENTS 

I. The Passing of Pills and Powders 3 

II. Home Doctoring 31 

III. The Advantages of Adipose 46 

IV. Dyspepsia 66 
V. Consider the Liver 94 

VI. Catarrh, our National Nasal Luxury 119 

VII. Asthma and Hay Fever 140 

Vm. Filter Mischief in the Body: Bright's Disease 

and other Kidney Troubles 167 

IX. The Unwisdom of Worry 187 

X. Heads and Hair: Why we grow Bald 199 

XI. Heart Disease 219 

XII. Sea-Sickness 246 

XIII. How we Grow Deaf 265 

XIV. Foot Faults 288 

XV. Our Foot Electrodes : Thunderbolts that strike 

us through our Feet 312 



vi CONTENTS 

XVI. The Lesser Perils of Country Life: Snakes in 

the Vacation Eden 330 

XVH. Insomnia and Insomniacs 349 

XVIII. Imaginary Diseases and their Inventors 377 

XIX. The Prevention of Old Age 405 

Index 439 



COMMON DISEASES 



COMMON DISEASES 

CHAPTER I 

THE PASSING OF PILLS AND POWDERS 

WHEN Eve ate the apple she was making an 
experiment in therapeutics. In this she was 
only living up to the professional obligations of her 
sex, probably with an eye to its use upon Cain and 
Abel in the next domestic emergency. Even the mis- 
ogynist Moses admits that it was because the fruit was 
"to be desired to make one wise." 

To this day the serpent is the symbol of medicine, 
of wisdom, and of Woman the Wise and the Inscruta- 
ble, She-Who-Must-Be-Obeyed. Woman is the oldest 
and not least worthy priest of iEsculapius, an echo of 
which still rings in the old proverb, "One old woman is 
worth a dozen doctors." 

When the good old mother in Israel trumpets her 
contempt for the medical profession with its "new- 
fangled fixin's," she has a past of a quarter of a million 
years to base her pretensions upon. 

The drug problem, the burning question both before 
and after taking, "What shall I take?" is one of the 
oldest in history. Even older, and far more respectable, 
than its sister query, "What will you take?" Though 
the answer was the same Life-Saving Remedy in the 
vast majority of both cases. 



4 COMMON DISEASES 

Woman was the earliest doctor, alcohol the first pa- 
tent medicine, as also the last; hence, perhaps, the 
antipathy between the sex and the drug. 

Nowadays we are inclined, not unnaturally, to 
associate drugs with the doctor; but as a matter of 
historic, or rather pre-historic, fact they are far older 
than he is. They were staples of household use ad- 
ministered by the Wise Woman long before he was 
invented. 

Our materia medica, our stock of known remedies, 
has been built up and tested and weeded out by the 
slow, painful experimentation of the whole human race 
extending over thousands of years. 

No better, more vivid illustration of the Darwinian 
method of progress, of the survival of the fittest, of 
wisdom slowly growing by bitter experience of repeat- 
edly doing the wrong thing, could be found than our 
growth in the knowledge of therapeutics, of the Art of 
Healing. Indeed, only from an evolutionary point of 
view can we consider it tolerantly and justly, with 
sympathy for human error and pity for its mistakes, 
and little inclination to hold any individual or class 
solely, or even chiefly, responsible for them. Doctor and 
patient alike are to be pitied rather than blamed for 
their costly errors and terribly punished mistakes in the 
long fight against ignorance, disease, and superstition. 

The mode of discovery of drugs was probably some- 
what in this wise. In his eager, unceasing, omnivorous 
search for anything that would add attractiveness to 
his menu in times of plenty, or stay his hunger in 
famine, primitive man unquestionably bit off, chewed, 



THE PASSING OF PILLS AND POWDERS 5 

and endeavored to digest almost every berry, plant, 
root, or leaf which grew out of doors in the region in 
which he lived — just as his twentieth-century avatar, 
the two-year-old toddler, will to this day, if his designs 
are not frustrated by the watchful eye of his mother or 
nurse. Anything within reach of his chubby clutch 
which is not too heavy for him to lift and whose narrow- 
est presenting diameter is not in excess of the widest 
possible distention of his rosy mouth, goes into it and 
will be swallowed if possible. 

Some of these near-foods were so prickly or so bitter 
that they were promptly spit out without being swal- 
lowed; others so dry and tasteless as to be worthless — 
except as breakfast foods. Others could be swallowed, 
but would n't stay down, and these became emetics 
and were advanced at once to a place of honor on the 
primitive medicine shelf. Others showed astonishing 
ingenuity in escaping from the body by another route, 
and became purges and cathartics. 

The seed capsules of a certain poppy which looked 
plump and nutritious were found, when chewed, to 
produce delightful sensations of drowsiness and com- 
fort, followed by golden dreams and purple visions 
ending in deep and profound sleep; and opium, the 
Pain-Conqueror, long hailed as the choicest gift of the 
gods to man, was discovered. Of course, it was early 
found that if you chewed too large a poppy head you 
might still get the drowsy comfort and rosy dreams — 
but you did n't come back to tell about them ; and this 
introduced such refinements as dosage in proportion to 
effects desired. 



6 COMMON DISEASES 

Another herb of intensely bitter taste, though un- 
attractive as a comestible, would make the muscles 
jump under your skin like grasshoppers, and your 
jaws snap together like a steel trap; while in larger 
amounts it produced swift and unpleasant death, with 
all external appearances of extreme discomfort. This 
was laid aside to be rubbed on arrow tips, or served 
cold to your enemy for breakfast; and, of course, it 
soon climbed up on the medicine shelf, under the name 
of strychnine, apparently on the principle that what 
would kill you in large doses must be peculiarly good 
for you in small ones. Or perhaps it was found useful, 
in the language of the ancient legend, in "throwing 
patients into fits," which could then be cured by incan- 
tations, providing you had guessed your doses cor- 
rectly. 

Yet another of these trial desserts, the thorn apple, 
our familiar "Jimson weed," was found, when eaten, 
to give an excellent imitation of insanity, with delu- 
sions and ravings ; of course a drug which would produce 
such astonishing effects as this upon a well man must 
do wonders for a sick one, and its family was promptly 
raised to the medicine shelf (by a sort of prophetic 
homeopathy) as a cure for mental derangements, 
under the name of hyoscyamus, where it remains to 
this day. 

Some greedy plutocrat of the Pliocene having one 
day gathered in a gourd more ripe berries than he could 
possibly eat, left the crushed surplus standing where 
the sun could get at them. His hunger returning in a 
day or two, he came back to finish them; but to his 



THE PASSING OF PILLS AND POWDERS 7 

surprise found them turned into a biting, frothy pulp, 
covered with rosy bubbles. He gulped it down, and 
in a few minutes began to see things about him as he 
never had seen them before, and Other Things that 
he had never even dreamed of. Even when he woke up 
with a headache his dreams came back to him in allur- 
ing guise, and by the time he had got the dark-brown 
taste out of his mouth, he decided that the game was 
worth another trial, and hastened to pick a bigger 
gourdful of berries and set it to brew. Thus alcohol, the 
Great Magician, with the sting in his tail, was born, 
and adopted as Big Medicine. 

The discovery of most of our standard drugs goes 
back beyond the dawn of history. We know no more 
when opium was first used than we know when, or 
where, wheat or maize was first used. History is either 
absolutely silent, or full of fairy tales to the effect that 
these blessings and curses alike were invented by some 
god-man, or even brought down bodily, like fire, from 
heaven. Certain it is that there was a full medicine 
chest of drugs before the doctor, or anything approach- 
ing him, was invented. 

At last the doctor comes on the stage of history in 
the guise of that strange functionary, the shaman, or 
Medicine Man, part priest, part doctor, part astrologer- 
scientist, and the common ancestor of all three; which 
is one of the reasons why science, medicine, and religion 
" scrap" so enthusiastically whenever they come to- 
gether — it 's a family affair. Healing becomes a pro- 
fessional instead of amateur matter, and the seeking 
and finding of drugs proceeds apace. Plants and herbs. 



8 COMMON DISEASES 

instead of being turned into medicine by the crude 
method of eating them indiscriminately, and then being 
guided by the symptoms and experience of the sur- 
vivors, begin to be tried with malice aforethought as 
remedies for a particular disease. 

The properties of an herb or root which suggested its 
use in some particular disease were often of the quaint- 
est and most extraordinary character. Liverwort and 
hepatica have each a leaf rudely resembling the out- 
line of the liver; therefore they ought to be of value 
in jaundice and biliousness, and for centuries they en- 
joyed high reputation as remedies in diseases of the 
liver. 

Seeds, berries, or leaves which happened to be either 
star-shaped, cross-shaped, or in the magic trefoil form, 
acquired all the occult powers which the symbolism 
of the day associated with the star, the cross, and the 
shamrock. Clover tea as a cure for cancer, for instance, 
owes its reputation solely to this symbolic association. 

Plants or roots with red juice were supposed to be 
good blood medicines; those from which yellow decoc- 
tions could be made had a corresponding power over 
the bile or the urine. Substances that were black, or 
would make a black decoction, were of extraordinary 
power in desperate diseases and serious maladies, both 
bodily and mental, which were believed to be due to 
possession by evil spirits. Even as late as Sir Walter 
Raleigh's day, during a serious illness, a black cock was 
split and applied warm and bleeding to the soles of his 
feet. The necromantic powers of a black cat and the 
deadly certainty of action by black pills, no matter 



THE PASSING OF PILLS AND POWDERS 9 

what they are made of, are household words. Only 
three years ago, within twenty miles of New York 
City, a case was reported to me by a cousin of the pa- 
tient, in which the still warm and bleeding skin of a 
freshly killed black cat was applied as a remedy for 
"shingles." 

Herbs, flowers, seeds, or roots were valued accord- 
ing to the place where they grew, the time of year at 
which they blossomed, the stage of the moon in which 
they were gathered, whether they were cut with a silver 
or an iron knife, and a thousand and one extraordinary 
connections were invented and believed in between 
remedies and the diseases which they could control. 
Plants that grew, for instance, around the tomb of a 
saint, would heal everything they touched, and even 
raise the dead; while those that sprouted in the rank 
grass at the foot of the gallows tree were correspond- 
ingly deadly and poisonous. We laugh at such things 
now; but most of us would go a mile out of our way 
on a dark night sooner than pass by a graveyard or a 
place where a man had been hanged. 

One remedy of wondrous potency in mediaeval medi- 
cine, the famous mandrake, or mandragora, owed its 
reputation solely to the fact that, its root being forked 
and its juice blood-red, it was supposed to resemble the 
human body and hence had marvelous powers over it. 

The wildest stories were believed about it: that it 
actually shrieked or cried out when it was being dragged 
from the ground, and that any one hearing that cry 
would die within sixty days! 

Hence mandrake-gatherers took with them a dog 



10 COMMON DISEASES 

which they tied to the plant, after very cautiously 
and gently loosening the earth about its root, and then 
retreated to a safe distance until his tuggings should 
have uprooted it. So the poor canine had to hear its 
death cries and bear the curse. They might have had 
the decency to use a cat, which would still have had 
eight lives left. 

Iron, now regarded as a blood food, was originally 
introduced into medicine as a new magic metal pecu- 
liarly obnoxious to evil spirits, which idea still survives 
in the familiar potency of the horseshoe as a charm 
against witches and all sorts of ill-luck. Later, by an 
even more familiar process of savage logic, it was be- 
lieved to impart to the body of the man who took it 
something of its own hardness and cutting keenness, 
just as the Indian ate the heart of the bear to give him 
courage. This impression was powerfully aided by its 
highly astringent, puckery taste. To this day, in Eng- 
land, they talk of a "steel" tonic and "steel" pills. 
This is not the only claim that iron has to be regarded 
as a tonic, but it was the original one. 

In the same way, nitrate of silver, lunar caustic, 
came to be used as a remedy in insanity and nervous 
disturbances, because silver was the color of the moon, 
and the moon, the goddess Luna, as every schoolboy 
knows, is principally concerned in the production of 
"lunacy." When a man is crazy he is still "moon- 
struck," or "looney." 

As Oliver Wendell Holmes records, in his early days 
nitrate of silver was a standard remedy for epilepsy, 
because this was originally believed to be caused by 



THE PASSING OF PILLS AND POWDERS 11 

the influence of the moon; and he himself had seen 
unfortunate epileptics so saturated with this drug that 
it had become deposited under their skins and black- 
ened by the light as on a photographic plate, so that 
their complexions were turned a dull, slaty gray. 

Gold was always a great favorite because, being the 
king of metals, it imparted some of its royal qualities 
to the body that absorbed it, and enabled it to resist 
the attack of disease as the noble metal itself resisted 
the bite of even the strongest acids. Upon this fond 
delusion of the popular mind was based the famous 
"Gold Cure" of only a decade or two ago. 

From such a seething welter of ignorance and super- 
stition, from such a witch's caldron of absurdities, have 
sprung the majority of our remedies in use to-day. This 
is chiefly due to the extraordinary and incredible an- 
cientness of drugs. Opium, for instance, is older than 
bread; and iron was first used as a medicine, because it 
was new and hence hateful to the old gods, in the 
Bronze Age at the latest. 

Is it any wonder that the struggle to rationalize med- 
icine, to bring order out of chaos, has been so tremen- 
dous and that progress in the fight against superstition 
and error has been so discouragingly slow? 

One of the greatest obstacles to progress, the gravest 
difficulty in sifting the helpful from the worthless, has 
been, and is yet, that, inasmuch as some eighty-five 
per cent of all illnesses get well of their own accord 
no matter what may be done or not done for them, 
any drug which is used with sufficient constancy and 
indiscriminateness in any disease will score eighty- 



12 COMMON DISEASES 

five per cent of cures, providing that it is not positively 
harmful. 

Even to-day it is one of the hardest but most neces- 
sary things to get clearly in mind that the triumphs, 
the "cures," achieved by any new remedy must be 
"loaded," as the calculators say, with this six-to- 
one standing handicap in its favor. It must not only 
be shown that seventy-eight per cent or ninety per 
cent of the patients who took a drug or other remedy 
got well, but that more of them recovered than of those 
who did not take it. 

This progress of therapeutic house cleaning, of 
" Transvaluation of Values" as Nietzsche called it, is 
precisely what the medical profession to-day is en- 
gaged in carrying out and applying to every drug upon 
its shelves and upon the pages of its pharmacopoeia. 
It is a huge undertaking, but we are looking forward to 
a magnificent clearance of ancient rubbish before we 
are through with it. 

Some drugs of real value will survive; but their num- 
bers will be counted by tens instead of by thousands, 
as at present. In fact, next after the fight against dis- 
ease, the biggest struggle that the coming doctor has 
on his hands is with drugs and the deadly grip which 
they have upon the confidence and the affection both 
of the profession and of the public. 

Another of the gravest difficulties of the drug prob- 
lem is that the oldest, most highly prized, and most 
universally used drugs are unfortunately the most 
dangerous and poisonous. The "simple, old-fashioned, 
household remedies" that we hear so much vaunted, 






THE PASSING OF PILLS AND POWDERS 13 

number among them the most dangerous drugs that 
we have. Laudanum or* paregoric or some "Pain 
Killer" or "Soothing Sirup," or other form of opium, 
stands on every family medicine shelf, just as it did 
under the eaves of the bamboo hut of primitive man. 
Alcohol in some form comes next, either as "Good 
Old Whiskey" or "pure, homemade wines" or cordials 

— many of them strong enough to blow your head off 

— or somebody's "Bitters" or "Tonic." Take away 
opium and alcohol, and the backbone of the patent-medi- 
cine business would be broken inside of forty-eight hours, 
because these are the only drugs known to science which 
will make any one, no matter what may be the matter 
with him, "feel better," for a little while, at least, after 
he takes them. 

Why such dangerous drugs came into vogue at such 
an early period in the history of healing is not far to 
seek. Primitive man was not much addicted to minor 
ailments. Like animals in a state of nature, he could 
not afford to indulge in "functional" diseases, — ■ like 
headache and hysteria and nervous dyspepsia and mus- 
cular rheumatism, — for he had to fight for his life 
every day, and sometimes two or three times a day; 
and if his head ached, or his arm or leg were stiff enough 
to handicap him more than ten per cent, he promptly 
fell by the wayside and was utilized for provender. 
Whenever he was sick, he was sick "for sure," as the 
vernacular has it; and he either died or got better with 
commendable promptness. 

So that whenever either the W T ise Woman or the 
Medicine Man was sent for, they usually found a pa- 



14 COMMON DISEASES 

tient who was either just about to die, or thought he 
was with some show of reason for his belief. It was no 
time for placebos or bread pills or gruels. Something 
had to be done or given which would produce an out- 
ward and visible sign of its inward and spiritual effects 
with neatness and dispatch. An emetic was a pretty 
good suit to lead from — you got visible returns at 
once; a cathartic, for equally obvious reasons, an 
excellent right bower; while opium was not merely 
trumps, but the ace of the same in almost every possi- 
ble hand that might have been dealt to you. 

Was the patient shrieking and writhing in the ago- 
nies of cholera, or a crushed chest, a single dose of the 
great Pain King would reduce him to a merciful, and 
by contrast, blissful state of unconsciousness within 
twenty minutes. Was he raving wildly in the delirium 
of fever or the delusions of insanity, opium would re- 
duce his frantic outcries to mere drowsy mutterings. 
Was he gasping for breath in the agonies of acute 
pleurisy, opium again would make his breathing like 
that of a tired child. Was cholera pouring the fluids of 
his very life-blood out of his body at such a furious 
rate that he was literally shriveling like a sucked orange, 
opium would throw a temporary dam across the flood 
and give the panic-stricken forces of the body a mo- 
ment's chance to rally in its defense. 

Is it any wonder that opium, alcohol, hasheesh, 
coca, or some other narcotic, came to be regarded as 
not merely a sheet-anchor in disease, but as a staple 
necessity of existence — even, by a grotesque twist of 
popular logic, as a food? Not a nation can be found, not 



THE PASSING OF PILLS AND POWDERS 15 

a tribe anywhere upon the surface of the globe, that 
does not possess the knowledge of one or more narcotics, 
and habitually uses one or another of them not merely 
as a medicine, but as a beverage, a luxury, or a sub- 
stitute for food. It is as easy to see how this extraordi- 
nary confidence in narcotics grew up and became so 
universal in the race as it is now to recognize how 
utterly illusory and delusive it was and yet is. 

Gradually, as doctors and patients both became more 
intelligent, it dawned upon them that drugs and po- 
tions were not indispensable to recovery, that fevers 
ran a fairly definite course and stopped of their own 
accord, that the majority of diseases tended toward 
ultimate recovery. Less and less violent methods of 
treatment were adopted, vomitings and purgings and 
bleedings became less universal, and the habit grew up 
of depending more upon diet, bathing, and rest, put- 
ting patients to bed and using drugs simply to keep 
them comfortable and assist the body in its fight. 

Finally, and it seems incredible that it was only about 
sixty years ago, we reached the point where we dared 
to let a few moderate cases of typhoid fever or pneu- 
monia or rheumatism run their own course to see just 
what Nature would do, interfering only in emergen- 
cies, or in case of serious danger. 

Results followed which are well under way to revolu- 
tionize the practice of medicine. First, the discovery 
that the healthy human organism possessed inherent 
powers of defense against disease, and that many of 
what we put down as symptoms of disease and even as 
parts of the disease process, such as fever, pain, vomit- 



16 COMMON DISEASES 

ing, diarrhoea, shivering fits and some forms of convul- 
sions, are parts of Nature's effort to get rid of the 
poison. Our proper function is to intelligently assist 
Nature in her efforts, instead of thwarting her at every 
turn and suppressing every symptom as quickly as 
we can find a drug club to beat it down with. We now 
cooperate with Nature in disease, as in health, and 
check her only when she seems to have become panic- 
stricken and going to dangerous extremes. Just when 
to help and when to hinder, and how to help without 
doing harm — these are the problems that call for 
brains in a doctor. 

The old, blind, implicit confidence in drugs is gone, 
the naive belief that if we could only find and give the 
one right remedy it would "do the rest," like some 
magic button when pressed. 

In its place is a wholesome, searching skepticism 
which demands proof, tests rigidly, rejects mercilessly. 
Scores of hoary old humbugs have already shriveled 
in its white light. As our modern physician-philosopher 
Osier phrases it: "He is the best doctor who knows the 
worthlessness of most drugs." 

All the hundreds of old standbys of our books on 
materia medica, the dozens of ancient inhabitants of 
our medicine chests, the scores of new cure-alls of the 
advertising pages and the prospectuses, are being rig- 
orously tested upon animals to find out their real and 
precise value and what it depends upon. Nothing is 
left to hearsay, or imagination, or expectation. 

The result already is a demand for the cutting down 
of the drug lists taught in our schools from four or five 



THE PASSING OF PILLS AND POWDERS 17 

hundred to fifty or less, while Osier goes so far as to 
speak of "the six or seven' real drugs!" 

Even this small group of "real" remedies is looked 
upon merely as a group of tools, whose results will de- 
pend chiefly upon the skill with which they are handled. 
Moreover, as edge-tools, which will cut both ways 
and do harm as well as good. 

No drug — save quinine, mercury, and No. 606 in spe- 
cial cases — will cure a disease : only rest, food, sunshine, 
and fresh air can work that miracle. 

All that medicine can do is to call a halt and give 
Nature time to rally her forces. As well use bugles in 
place of bayonets as drugs in place of food or fresh air. 

Meanwhile we are coming to use the remedies which 
survive from the past, and the new weapons put in our 
hands by modern science, in a new and often radically 
different manner. 

Whole groups and classes of drugs are falling into 
disuse and new ones coming into play. Emetics, for 
instance, are being replaced by the stomach tube; ca- 
thartics by dieting and intestinal antiseptics; while 
tonics are falling gradually into disrepute because we 
have not the least idea what we mean by the term or 
how they produce their alleged effects save by their 
bitter taste or their influence upon the imagination of 
the patient. The only real tonics are cold air and ex- 
ercise followed by food. As the great Boerhaave long 
ago declared, the best way to get benefit from the bitter- 
wood tree (quassia) is to climb up it, or chop it down. 

On the other hand, since the priceless discovery that 
so many of our diseases are due to the pernicious activ- 



18 COMMON DISEASES 

ity of bacteria, or germs, a brand-new class of remedies 
has grown up — the antiseptics or germ-killers, both 
external and internal. Antiseptics will one day do as 
wondrous service for medicine as they have already 
for surgery; but at present their utility is sadly limited 
by the fact that, the human body being simply a colony 
of animal germs, they are almost as deadly to our own 
cells as to the invading bacteria. 

We have a few already which kill the germs without 
injuring the body, such as quinine in malaria and mer- 
cury and "606" in syphilis, and the laboratories are 
working night and day to add to the number. 

Poisons are being invented, and even specially 
created by modern synthetic chemical methods, to kill 
each particular germ or organism. 

Some idea of what may one day be hoped for may 
be glimpsed in the late announcement of Ehrlich that 
he had built up a new arsenic compound, with a seven- 
syllabled name, the already famous " 606 " or Salvar- 
san, which would clear the blood of the spirocheta of 
syphilis in forty-eight hours, a feat which mercury 
takes from three to nine months to accomplish. The 
tests made of it so far support this claim in a remark- 
able manner, but, of course, thousands more must be 
made before we can accept his claims and assign the 
new remedy its final place. 

But our most valuable and hopeful modern 
"charms" against disease are leaves plucked from 
Nature's own book. 

Like the early Quakers, we are turning to the "light 
within" and utilizing our own internal, homemade 
remedies. 



THE PASSING OF PILLS AND POWDERS 19 

When a fever "runs its course" and we begin to 
recover, we do so by virtue of certain antidote sub- 
stances or antitoxins formed in our blood, which neu- 
tralize the poisons or destroy the bodies of the invading 
germs. 

These antidotes are usually present in small amounts 
in all healthy blood; indeed, a sound, vigorous body is 
a most inhospitable and unwholesome place for strange 
germs to wander into. This is why not more than one 
in five of us who are exposed to an infectious disease 
ever catch it. 

The entrance of the disease germs starts the body 
cells to pouring out more of these antibodies, as surely 
as the intrusion of a strange cat into a garret sets all 
the resident felines to bristling and spitting, and almost 
as mechanically as the bark of a pine tree pours out 
protective gum when bruised. 

If the body cells can "do it first" and hurry enough 
troops to the front, then the invaders are overwhelmed 
by the antibodies and either killed and eaten on the 
spot, Fiji-Island fashion, or handcuffed and thrown 
into jail, or simply deprived of their weapons and set 
at liberty under bonds to keep the peace. This may 
sound like romancing, but it is merely a figurative 
transcript of what literally happens, the "hostiles" in 
the first case being eaten by the leucocytes, or white 
blood cells ; in the second engulfed and imprisoned alive 
in their bodies, or in masses of body cells poured out to 
bury them — and from either of these prisons they 
may later escape and produce a relapse; while in the 
third the poisons or toxins of the germs are merely 



20 COMMON DISEASES 

"antidoted" by the antibodies and the germs them- 
selves remain in or wander harmlessly through the 
body. 

The problem is how to get hold of the natural anti- 
bodies or antitoxins in sufficient amounts to use them 
in curing or preventing disease in others. 

As they remain for years in the blood of their "manu- 
facturers," protecting them against a second attack of 
the disease, often even for life, giving them the original 
"immunity bath," now so popular with other and 
larger corporate bodies — it was first attempted to 
secure them from the blood of convalescents. 

This was found impracticable because the blood was 
never rich enough in these bodies to give the small 
amounts available any power over disease germs 
when diffused all through the blood of another patient, 
although they might check their growth undiluted in 
a test tube. 

Indeed, after some diseases there was almost no free 
antitoxin in the blood, the cells seeming to have only 
learned the knack of producing it as it was needed. In 
fact, immunity, like wisdom and other fruits of experi- 
ence, can seldom be passed on to others. 

Our only resource was our friends, the animals; and 
by selecting a species which had a fair degree of resist- 
ing power to begin with, injecting a moderate dose of 
the bacilli in question, then as soon as it had recovered 
a larger one and so on, we succeeded in getting the 
blood so loaded with antitoxin that even doses which 
could be safely injected with a hypodermic syringe 
would contain enough to stop the progress of the germs. 



THE PASSING OF PILLS AND POWDERS 21 

This process carried out upon the horse gave us our 
first and greatest triumph in antitoxin medication, the 
diphtheria antitoxin, whose marvelous victories are 
already a household word. 

It is only a question of time when we shall possess like 
cures for many other diseases. But the difficulties in 
the way are grave, and will take time and many labo- 
rious and expensive researches to overcome. 

In some diseases, like typhoid and tuberculosis, the 
antitoxin is only produced, as described, in very small 
amounts at a time, so that we cannot collect enough of 
it even from the blood of animals after successive inoc- 
ulations. In others, like pneumonia, apparently only 
just enough to check the disease is made and no surplus 
whatever left, so that the patient is just as liable as be- 
fore to have a fresh attack; in some cases even more 
so. 

An even more hopeless and curious condition is 
found in tuberculosis, where the bacilli, to a consider- 
able degree, like the black-and-white furry infester of 
our henroosts, do not discharge their poisons unless 
attacked and partially broken down by the body cells, 
so that to inject larger amounts of an antibody or anti- 
toxin may mean the liberation of larger and more 
dangerous amounts of the germ poisons. 

In other diseases, the crux of the problem is that we 
have no known animal which will "take" the infection 
and hence form antidotes against it. 

This halted and puzzled us for years in smallpox, in 
syphilis, in cerebrospinal meningitis or " spotted fever," 
and in infantile paralysis. 



22 COMMON DISEASES 

Finally, it occurred to investigators that man's 
nearest of blood kin, the monkeys and apes, might 
prove susceptible to his peculiar diseases. When the 
expense of securing and difficulties in keeping and han- 
dling had been overcome, within two years we had 
by this means discovered the germs of syphilis and 
probably smallpox, an antitoxin for "spotted fever," 
and the foundations for a weapon against infantile 
paralysis. 

These last two achievements fall to the credit of 
American science through the enterprise and industry 
of the Rockefeller Institute and its brilliant head, 
Professor Simon Flexner. 

The death rate in spotted fever has always been 
high, nearly three fourths of those attacked dying, and 
half the survivors being left blind, deaf, or paralyzed 
for life. No remedy had the slightest effect. 

The Flexner antitoxin, or serum, has now been 
tested upon some thirteen hundred cases, scattered all 
over the world, and over three fourths of those treated 
have recovered, thus almost trebling the former rate ! 

Infantile paralysis, whose wide distribution all over 
the country is now exciting so much uneasiness, as it 
kills nearly a tenth of those attacked and leaves two 
thirds of the remainder more or less crippled, is still a 
puzzle. But its solution is practically in sight, for while 
the researchers at the Rockefeller Institute have not 
yet succeeded in identifying the germ, they have been 
able to transmit the disease to monkeys and to pass it 
through a series of these, thus rendering the production 
of an antitoxin probably only a question of time. 



THE PASSING OF PILLS AND POWDERS 23 

There is also another way in which germs and their 
products have been harnessed in our service, for the 
cure and prevention of disease. On a sort of reversed 
"hair-of-the-dog-that-bit-you" principle, small doses 
of an infection, which in large ones might kill you, 
will save your life. The process might be described as 
" curing in advance." 

Very small doses of virulent germs, or larger doses of 
the germs weakened by heating, or exposure to light, 
or growth under unfavorable conditions, are injected. 
These set up a sort of imitation attack of the disease, 
and produce such large amounts of antitoxin in the 
body as to protect it against a full-strength infection. 

This protection may last for years, or even for life, 
and is the well-known vaccination, longest practiced 
and best known against smallpox. The disease vaccinia, 
which produces the familiar vaccine virus, is smallpox 
which has passed through a long series of cows and 
possibly through a series of horses before that, though 
this is not certain. It has become so much milder as to 
be free from danger to life, but gives as complete protec- 
tion as a full attack of virulent smallpox, only not for 
so long a time, from five to fifteen years instead of for 
life. 

For many years vaccine virus was our only vaccine, 
but now we have a dozen or more of positive value and 
as many more claimants for the honor. 

The best and most widely used so far is that against 
typhoid fever. This consists of an injection of dead 
typhoid bacilli and their toxins, killed by heat. It 
produces a slight attack of headache, feverishness, and 



24 COMMON DISEASES 

discomfort, lasting three or four days, which forms 
enough antitoxin to give a marked though not com- 
plete immunity against the disease for from three to six 
months. On account of the shortness and incomplete- 
ness of the immunity, it has been chiefly applied so far 
to soldiers entering upon a campaign in the tropics, or 
others who expect to be markedly exposed to infection 
for the following few months. Its results have been 
very encouraging. In large bodies of troops inoculated, 
less than one fourth as many contracted typhoid as in 
unprotected regiments camping and campaigning with 
them; and of those who contracted the disease, scarcely 
a third as many died, making the net death rate more 
than ten times as great in the unprotected men. Now 
by a succession of inoculations at intervals of several 
weeks the period of protection has been lengthened to 
two years and possibly, after four inoculations, for life. 

The method was devised by Sir Almroth Wright, 
then Chief Pathologist in the Medical Department of 
the British army, and first extensively used upon 
the troops in the Boer War. It has been steadily 
worked at ever since, and of late largely used on our 
American troops in the Philippines and on the Mexican 
border with encouraging results. By other methods of 
modifying the cultures injected, the "imitation at- 
tack" has been made milder and the period of protec- 
tion longer, reaching a year or more, so that it is now 
being advised for general use and also for curative pur- 
poses in an attack of typhoid by hastening the 
"piling up" of the antitoxin in the blood. 

We have also vaccines which give excellent results 



THE PASSING OF PILLS AND POWDERS 25 

in a certain percentage of cases of boils and other so- 
called pus infections; and even "common colds," which 
are almost always infections, are often effectually 
treated and cut short by injecting into the blood killed 
cultures of the germs found in the nasal or throat dis- 
charges of the sufferer. 

Thus our line of defense against those numerous 
diseases which are due to the attack of germs from 
without has been greatly strengthened by the new dis- 
coveries, but how as to our foes within, the disturb- 
ances due to changes and upsettings of balance in our 
own body chemistry? We are making advances here 
also, not as marked or as striking yet, but of almost 
limitless promise for the future. 

In our search through the body for antibodies and 
antitoxins, we discovered that our blood and all our 
vital fluids were full not merely of liquid food and waste 
substances, but of natural tonics and sedatives, of 
stimulants and restorers of the body balance generally. 
In fact, we are walking pharmacies as well as machines 
and thought factories. 

These original "blood medicines' ' are the so-called 
internal secretions, or enzymes (ferments). To put it 
very briefly, each one of the great solid or glandular 
organs of the body — the liver, kidney, pancreas, thy- 
roid, thymus, suprarenal, et cetera — pours into or 
takes out of the blood one or more of these ferments, 
which are absolutely necessary to the health of the 
body. If any of these enzymes is deficient in amount, or 
poured out in excess, disease results. 

When we have got their precise relations to each 



26 COMMON DISEASES 

other and to the bodily health more thoroughly worked 
out, it is not improbable that we shall gain as great a 
mastery over internal diseases as we now have over ex- 
ternal ones, by finding out which enzyme or ferment is 
deficient and then supplying it from the corresponding 
gland of some healthy animal. 

For instance, it is already known that diabetes is 
largely due to the failure of an enzyme produced by the 
pancreas, the great digestive gland of the upper bow- 
els; that a peculiar form of dwarf idiocy known as 
cretinism, and myxedema also, are due to deficient secre- 
tion of the thyroid gland, which lies just on either side 
of our "Adam's apple" and when swollen produces 
goiter; that arteriosclerosis, the decay of the muscular 
coat of the walls of the blood vessels, which plays such 
an important part in heart disease and kidney disease, 
as well as in premature old age, is closely connected 
with the secretion of the suprarenal gland, lying just 
above the kidney. 

It is not improbable that the failure of some glandu- 
lar enzyme is the underlying basis of that terrible rebel- 
lion of the cells, cancer. In fact, internal medicine has 
as many triumphs in sight as surgery has already 
achieved. Already by the administration of the ex- 
tract of the thyroid gland of the sheep we can turn a 
semi-idiotic dwarf of thirty years into a fairly intelli- 
gent, well-behaved, self-supporting human being of 
about two thirds normal stature and powers, a comfort 
and a help to his family instead of a burden and an 
affliction. 

An extract of the suprarenal gland of the sheep is one 



THE PASSING OF PILLS AND POWDERS 27 

of our most useful remedies in certain diseases of the 
heart, blood vessels, and kidneys, and the list of these 
"natural drugs" is growing swiftly, nearly a dozen 
"glandular extracts" being in common use. 

Ovarian extract, for instance, is widely depended 
upon for the relief of disturbances of this function. 

Further and still more curious, we have found 
that the different organs of the body send a variety 
of "messenger-boy" substances through the blood, 
known as hormones, to stir up the activities of other 
cooperating glands or organs. For instance, the mouth 
sends hormones, picked up from the food, through the 
blood to the stomach to warn it what sort of gastric 
juices to secrete, and the stomach sends other messen- 
gers on a similar errand to the pancreas and bowels. 

The muscle cells all over the body when their blood 
supply becomes impure, send a hormone (carbon di- 
oxid) to the medulla, at the base of the brain, to make 
the lungs breathe deeper and the heart beat faster. 

Some of these "messengers" have been identified 
and extracted so that we can now use them to stimu- 
late the activities of certain glands and organs at 
will. 

It looks as if the medicine chest of the future would 
be largely stocked with antiseptics, antitoxins, glandu- 
lar extracts, and hormones, or " messenger" substances. 

The most rigorous testing and scrutiny are being 
applied to all new remedies with which both manu- 
facturing chemists and laboratory workers are supply- 
ing us, many of them of great interest and value. Two 
special councils or bodies of experts, for instance, are 



28 COMMON DISEASES 

appointed by the great national medical associations 
of both England and America, to whom are submitted 
all new drugs, preparations, glandular extracts, anti- 
toxins, et cetera. These they submit, first, to most 
rigorous chemical analysis; second, to actual tests upon 
animals; and third, if they survive both these, to intel- 
ligent and cautious administration in the hands of 
selected physicians. 

Full reports are then published in the columns of the 
medical journals of the associations; and while there is 
nothing obligatory about their findings, the practical 
result is that a rapidly increasing number of intelligent 
physicians and of the more progressive hospitals abso- 
lutely refuse even to try any remedy until it has passed 
the tests of these examining bodies and proved itself to 
be of real merit and free from danger. What is even 
more practical in its effect, the leading journals on 
both sides of the Atlantic refuse to accept, or publish, 
the advertisements of new remedies which have not 
passed these tests. 

Of course it goes without saying that the heaviest 
artillery of our future warfare against disease will be 
directed toward its prevention rather than its cure. 
The best and only radical cure of disease consists in 
preventing its spread and wiping out the conditions 
which alone render its existence possible — poor food, 
dirty water, bad drainage, dark and ill-ventilated 
houses, overwork, under-pay. More and more of our 
energy and brain power will be devoted to the cheerful, 
positive task of keeping our bodies so strong and whole- 
some and vigorous that they can defy disease, instead 



THE PASSING OF PILLS AND POWDERS 29 

of the negative and melancholy one of patching them 
up after they are sick. 

But as long as accidents can happen, disease will 
occur; and there is little merit and but cold comfort 
in lecturing a drowning man upon the folly of having 
stepped upon a rotten plank or waded beyond his 
depth. We must throw him a rope of some sort, with a 
noose on the end of it, and try to get it over his head 
even at the risk of half strangling him. 

Drugs are playing a rapidly diminishing part in our 
war upon disease, but they will long be necessary for 
such emergency, life-preserver uses, and in skilled 
hands will be of priceless value and save many a life. 

The battle for health is set upon a titanic scale, 
a veritable Armageddon. The huge and incalculable 
interests at stake, the enormous labor, the tireless 
research, the vast expense, the endless repetition of 
test after test, put it beyond individual powers and 
resources. 

It is not complimentary to the intelligence of our 
statesmen, to the good sense of our people, to see our 
great national and state governments stand idly by 
and allow nine tenths of the burden of the vast warfare 
for the public weal to be borne by individual workers 
or by private munificence. We urgently need a great 
National Board or Department of Health, such as all 
other nations in the van of civilization already have, 
to search out the causes of disease and the means for 
their removal, to prevent the spread of disease, to 
protect the purity of our interstate streams and water 
supplies, to bar out epidemics from abroad, and to 



30 COMMON DISEASES 

curb the greed that produces unsanitary conditions at 
home. 

The relief of disease is no longer a matter of provid- 
ing a few magic powders or.soothing potions. We have 
got past that. 

We no longer believe that any drug, of itself alone, 
will cure any disease. It must, like Turner's colors, be 
"mixed with brains"; and those same brains, applied 
to a search for and removal of the cause, will cure far 
more diseases without any drug at all. Food, rest, sun- 
shine, exercise, bathing, massage — these are the 
sheet-anchors of our new materia medica. 

No longer is the doctor inseparably associated with 
the druggist and the undertaker. 

Soon he will prove that the only necessary connec- 
tion between doctors and drugs is that both begin with 
the same letter. 



CHAPTER II 



HOME DOCTORING 



NOT all our memories of the past are rosy. Lov- 
ingly as our thoughts may linger around the old 
swimmin'-hole, the little trundle-bed, the moss- 
covered bucket, "the little window where the sun 
came peeping in at morn," there is one rather vivid 
chapter of our childish recollections which they dis- 
tinctly prefer to skip. A golden mist still hovers about 
the memories of baking-day, but an exhalation of 
totally different color — and aroma — surrounds our 
recollections of spring medicines, boneset tea, castor 
oil, and Gregory's powder. Have we ever tasted any- 
thing quite so nasty since? 

And the bitterer they were the better, the more con- 
fidence was felt in them. One of Frank Stockton's 
delightful mothers in Israel had such a remedy, which 
had never failed her. It always cured Jabez, no matter 
what ailed him. "Makes no difference how bad he is, 
within twenty minutes of the time he's tuck it, he's 
well; would n't know any thin' wuz the matter of him 
'ceptin' a bitter taste in his mouth." 

Nor was this bitterness a mere accident. On the 
contrary, it throws an interesting light upon the origin 
not merely of household remedies but of medicines in 
general. 



32 COMMON DISEASES 

The earliest conception of disease of which our sav- 
age ancestors were capable was unquestionably the old, 
familiar one of demoniac possession. Even to this 
day the language of the sick-room is full of traces of it. 
The patient is "attacked" by pneumonia, is "seized" 
with a chill, "throws off " a cold or "is thrown into" a 
convulsion, should "feed" a fever and "starve" a cold, 
is ' ' threatened ' ' with typhoid. Disease is a personality , 
to be avoided, fought, conquered, frightened into 
leaving. 

To drive out this demon are naturally and logically 
employed the horrid noises and incantations, the beat- 
ings and poundings, not only of tom-toms, but of the 
luckless patient himself, of savage medicine, the hor- 
rible smokes and vapors, the nauseous messes and bit- 
ter drafts, the violent extremes of the steam-hut and 
the ice-plunge, the drastic emetics and purges — any- 
thing to make the place too hot for the bad spirit. 

Of the tom-toms nothing remains save an occasional 
sentimental vaporing about the cure of mental diseases 
by sweet music, of the poundings and punchings only 
the "bone-setters" and the rougher parts of osteo- 
pathy, of the smokes and vapors only incense and 
assafoetida, the classic burnt-feathers and smelling- 
salts; but of the nauseous messes, bitters, and purges a 
whole brood of every-day remedies, ranging from bone- 
set to the bitters of our pharmacopoeia, and from 
"seeny" tea to calomel. 

Domestic medicine, being an echo of the regular 
medicine of a century or two ago, naturally retains 
more of these bitter and nauseous survivals. No need 



HOME DOCTORING 33 

of proof, to any one who remembers his own experi- 
ences, that household remedies are of demonic origin in 
more senses than one. Their taste proves their pedi- 
gree. Among the ignorant, whether in the slums of our 
large cities or in remote rural districts, no medicine 
inspires much confidence unless it be either bitter or 
nauseous. 

In my student days in a London hospital we had in 
the pharmacy a large demijohn of a mixture known as 
"The Dead-Shot." It was compounded as follows : Into 
it were thrown all the odds and ends of drugs left over 
from making up other formulas, then a handful each of 
aloes, cinchona bark (crude quinine) and assafcetida 
and a pint of tincture of capsicum were added, and the 
carboy filled up with water. 

This made a tonic of gorgeous potency, smelling 
to high heaven, which would pucker your mouth clear 
down to the diaphragm and make your eyes water for 
twenty minutes after taking — but had absolutely no 
special therapeutic effect and was perfectly harmless. 

Whenever one of the old chronic medicine-takers, 
the sort who enjoyed ill-health and came to the dis- 
pensary chiefly for the pleasure of talking over their 
symptoms, — and there are scores of such among the 
poorest as well as among the rich, — began to get 
troublesome and complain that his medicine was n't 
doing him any good, "did n't seem to have no stren'th 
to it," the "Dead-Shot" was prescribed. 

Its effects were always good. Either it drove the 
malingerers away entirely or they would come back de- 
lighted to brag of its effects: "That's somethin' like a 



34 COMMON DISEASES 

med'cin'. I could just feel it take hold!" "Why didn't 
you gimme that before, Doctor?'' 

But is this the only value possessed by bitters of all 
sorts? By no means. Used indiscriminately at first, 
just because they were bitter, certain of them gradually 
were found to have positive curative properties, in 
certain conditions: such as quinine in ague, aloes in 
constipation, strychnine and caffeine in depression, 
opium for the relief of pain, gentian in loss of appetite. 
The fittest and most useful survived and were gradu- 
ally assigned to their proper places in the treatment of 
disease. Others were found so poisonous or so irritating 
that they were given up entirely, though I have several 
times heard an infusion of peach leaves, containing 
a dangerous amount of prussic acid, warmly recom- 
mended as a sovereign home remedy for ague. 

You will remember there was a virtue in quantity. 
The more you could drink the more good it would do 
you. Trifling rewards were offered for cups above so 
many, or a generous rivalry in bibulousness between 
Sister Sue and yourself was encouraged. You drank 
till you felt like bursting, then you were put to bed in 
hot blankets and, oh, how you did sw — pardon me — 
perspire ! When you woke next morning your cold was 
gone, or at least "real loose." 

The hot water and the warm blankets did the work, 
the "yarb" got the credit — just like scores of other 
medicines, not all of them domestic, by any means. 
Any remedy, or procedure, that involves hot drinks 
or baths, sweats, and rest in bed is safe to score a high 
percentage of cures. 



HOME DOCTORING 35 

Then there were the spring medicines of happier 
memory, the cheerful pink color and spicy taste of 
sassafras, of sarsaparilla, of cherry-bark, of slippery- 
elm, the heavy, gritty sweetness of sulphur and m'las- 
ses (Anglice, brimstone and treacle), and the wild 
spring greens and dandelion, hops, pokeweed, which 
were "so good for the liver." 

It is a little difficult to assign any definite origin for 
this curious group, or to give any rhyme or reason why 
"in the spring the young man's fancy" should "lightly 
turn to thoughts of" — sarsaparilla. Most of them are 
as absolutely inert as rose-water, and can at best be 
described as simply harmless and comforting. How the 
impression ever arose that they or any other kind of 
medicine were habitually required at this time of year 
seems hard to conjecture. 

A vague popular feeling appears to have been in the 
air in all ages that a fast, a spare diet, and vegetable 
infusions in the place of strong liquors, are desirable at 
this time of the year. An explanation quite commonly 
given by those who use them is that they "thin the 
blood." 

No one who has not experienced it can conceive of 
the tremendous and ravenous hunger for green stuff, 
fresh fruit, or anything approaching them, which 
comes on in the late winter and early spring months on 
farm diet. There have been no vegetables except pota- 
toes, and perhaps sauerkraut, for months. The apples 
have given out soon after New Year's, and, until the 
fashion of canning fruits came in, there was little or 
nothing to take their place. This was also the time of 



36 COMMON DISEASES 

the keenest pinch of hunger for primitive man, when 
game was scarcest and his little hoard of nuts and ber- 
ries most likely to be exhausted. No doubt in the 
spring he was habitually driven to eat bark, roots, 
leaves, anything that he could get; and it is barely 
possible that in these fragrant teas made from the 
spiciest and least bitter of the barks and roots we may 
have a sort of memorial service over the remains of the 
savage primeval spring bark-and-root hunger. 

Certainly, with the spread of the methods of canning 
fruits and vegetables, and particularly since the intro- 
duction of that priceless vegetable-fruit which keeps 
tart and fresh, even though canned, the whole year 
round, the tomato, and the use of the hotbed, or even 
the importation of Southern-grown lettuce and rad- 
ishes, the spring-medicine habit has rapidly waned. 
As a shrewd old farmer's wife remarked to me twenty 
years ago, "I find pie-plant 's the best spring medicine 
for my folks." 

In other communities the spring-medicine idea seems 
to have taken a form based on the belief that there 
have accumulated in the body during the winter a 
mass of waste materials popularly known as bile, 
spleen, "janders," and that something is necessary 
to get this out of the system, said something usually 
being in the form of a more or less drastic purgative. 
But the necessity for this, if it ever existed, has, of 
course, also entirely disappeared with the vast im- 
provement in modern diet. 

This, however, brings us naturally to the sheet- 
anchor of the home physician — laxatives. These 



HOME DOCTORING 37 

again have a very interesting history, the same min- 
gling of an utterly irrational origin with a gradually 
restricted rational use. Primarily there is no question 
but that they were all of one piece with the tom-tom 
and the bitter draft, namely, for the purpose of making 
an evil spirit so uncomfortable that he would leave the 
patient, or, by a crude literal! zation of metaphor, to 
actually sweep him out of the body. 

Even to this day this is the attitude toward them of 
a considerable element of the more ignorant classes of 
our community. Their first instinct, when they feel 
themselves out of sorts in any way, is to take some- 
thing that will "get it out of their systems." 

I have often heard my colleagues in Scandinavian 
communities of the Middle West say that, if you 
did n't give a Norwegian farmer a powerful laxative 
as your first dose, he did n't think you were any doc- 
tor at all. I have come across this feeling hundreds 
of times in the country districts, both East and West. 
In fact, it is always advisable, before prescribing a 
laxative, to inquire whether the patient has not already 
taken one, no matter what the disease may be. I can 
well remember hearing a colleague most bitterly criti- 
cized by the friends and relatives of a Welsh miner, 
who succumbed to his injuries two or three days after 
being frightfully burned in a mine explosion, because 
he had not given the victim any purgative to "take 
the fire out of his system." If he had done so the patient 
would certainly have recovered, in their opinion. 

There is nothing in all her household medicine chest 
upon which the Wise Woman of the neighborhood will 



38 COMMON DISEASES 

dwell more lovingly than the virtues and the conquests 
of her favorite laxative, whatever it may be. The feel- 
ing is the same in Occident or Orient, and has never 
been more delightfully phrased than by the shrewd old 
Hindu grandmother in Kipling's "Kim," who speaks 
in terms of wonder and admiration of an astonishing 
pill given to her by Hurree Chunder Sen, which was " of 
the tiniest, oh, scarce a millet-seed, so small one could 
hardly see it; yet once swallowed it wrought like a devil 
unchained!" 

Primarily, speed and vigor of action being the chief 
desiderata, the most drastic and even dangerous reme- 
dies were not merely used, but actually preferred: 
croton oil, gamboge, elaterium, dram doses of calomel, 
and half-pound doses of salts. These, of course, did 
the maximum of harm with the minimum of good in 
both lay and professional hands, and were gradually 
either completely discarded or enormously reduced in 
dosage. Great as has been the improvement, by the 
introduction of milder remedies and the use of com- 
paratively insignificant doses, laxatives still play far 
too large a part in medicine, both household and pro- 
fessional. They have a field of usefulness which is both 
wide and important, but the blind belief in their value 
as a preliminary measure under all sorts of conditions 
is rapidly dying out. How widespread this confidence 
in them was at one time is amusingly illustrated to this 
day in the experience which has been had scores of 
times by every practicing physician as to the effect of 
pills. 

Pills were originally invented for the administration 



HOME DOCTORING 39 

of laxatives only, covering up their bitter taste. This, 
of course, could not be done with the pure bitters or 
bitter tonics, as an important part of their virtue was 
believed to reside in the taste. Hence, bitters and 
laxatives being far the most common medicines, any- 
thing which was in pill form was supposed to be purga- 
tive. 

To this day if you give the average patient a pill, es- 
pecially if it be black, and to be taken at bedtime, he 
is almost certain to think that he is taking a laxative. 
Indeed, I have heard colleagues assert that all that was 
necessary was to administer one or two black pills at 
bedtime, regardless of what they might contain, to get 
such an effect. 

Peace to the memory of the old home laxatives! 
They had their uses, and still have, within proper limi- 
tations, and out of the ruck of them have emerged 
many valuable and fashionable modern remedies, like 
cascara, podophyllin, euonymin, and aloin. 

Next in the affections of the house-mother after her 
bitters and her laxatives came her oils and liniments. 
They were a rich and unctuous group, and their per- 
fumes were hardly those of sachet powder: Goose 
grease with an onion boiled in it, or, better still, fried 
and dropped in hot chicken fat; bear's grease; rarer 
and more wondrously effective, skunk oil, secured at 
Heaven knows what risk to clothing and noses; and 
crown jewel of the cabinet, rattlesnake oil. Nor were 
their virtues restricted to the comparatively narrow 
field of the modern liniment: sprains, bruises, or 
swollen joints. Rubbed on the chest, they were a sover- 



40 COMMON DISEASES 

eign remedy for croup or bronchitis, rubbed on the 
back they would cure the whooping-cough, put on the 
soles of a child's feet they would prevent night-sweats. 
As for rheumatism or bruises, just show me the case 
that they would not cure within five applications ! 

Now, there is no question that they can point to 
thousands of cures to their credit, but widely remote as 
may be their origins and extraordinary their character, 
they had one thing in common, they all had to be 
"rubbed in thoroughly," and the more thorough and 
tireless the rubbing, the more completely the oil was 
made to " disappear," the better would be the results. 
In fact, their virtues were solely due to the vigorous 
massage which accompanied their use. It was believed 
at one time that this industrious "rubbing in" caused 
them to be absorbed, and of course, in the crude logic 
of the peasant, oil rubbed into a stiff joint might natu- 
rally be expected to lubricate it somewhat. This is now 
known to be a delusion, as practically nothing can be 
absorbed through the human skin. All remedies which 
are administered by " rubbing in " are now known to be 
volatilized by the heat of the body and their vapor 
inhaled through the nose and mouth. An interesting 
illustration of this is given in the use of the oils already 
alluded to, namely, either those which had a strong 
aromatic odor of their own, or were impregnated by 
means of onions, turpentine, "camfire," and ammonia. 
Such benefit as they might give when rubbed on the 
chest or back of the patient suffering from lung trouble 
was due to their aromatic element being volatilized 
and inhaled into the lungs of the patient. 



HOME DOCTORING 41 

We must not forget the poultices, warm, soft, cling- 
ing; what relief they did give to the aching muscle or 
the throbbing joint! Their name also was legion. 
Linseed, bran, slippery-elm, hops, potato, bread-and- 
milk — anything that could be made into a pulp so as 
to retain moisture and heat. 

The poultice-makers had their flights of the imagin- 
ation as well as the poets. A very common dressing in 
the country districts for either a fresh wound or abscess 
is a large quid of fine-cut tobacco, affectionately chewed 
and bound upon the part. If it happened to be an un- 
broken abscess, boil, or swelling, no particular harm 
was done, but if it were an open wound, absorption 
of the tobacco might take place in alarming amounts; 
and serious symptoms of nicotine poisoning have been 
reported from all over the country from this cause, and 
even one or two deaths. 

Occasionally a little bit of the old, demoniac tend- 
ency to use the outre or the disgusting crops out, as in 
the case of the familiar poultice of barnyard manure, 
which almost every one has heard suggested, and the 
firm belief in very remote regions that a black chicken 
or cat, killed, and split open while still warm, makes a 
splendid application to a rheumatic joint. 

I remember in the early days of my practice a small 
boy who was brought into my office by his mother, to 
have an abscess on his finger looked at. I attempted to 
remove the home-dressing which he was wearing, and, 
after getting off the outside layer, found myself con- 
fronted by a brown, sticky, slippery mass in which the 
thumb was completely imbedded. It had a curiously 



42 COMMON DISEASES 

fruity smell which seemed familiar, and, on turning to 
the mother, I found that one of her neighbors had ad- 
vised her to thrust the affected thumb into the centre 
of a rotten apple and then bind that on, which she had 
religiously done. As a poultice it was a great success, 
for I do not think I ever saw so large a felon on so 
small a thumb. 

But alas ! the poultice must go the way of the fairies. 
Soothing and comforting as they were before the days 
of antiseptics, modern science will have none of them. 
While they relieve pain, they encourage the growth of 
the micro-organisms which produce inflammation, and 
their effect is usually to either turn a simple inflamma- 
tory swelling into an abscess, or to make a small abscess 
develop into a larger one. Not only that, but they 
soften the surrounding surface, and furnish a splendid 
hotbed for the streptococcus to both grow in and travel 
under to other portions of the skin. 

Many and many a time do we see a single boil, for 
instance, which has been poulticed, followed by a crop 
of secondary boils, which have sprung up all around the 
first one, like a " fairy-ring " in the grass, under the 
sheltering cover of the poultice. The modern antisep- 
tic dressing, with an evaporating lotion, not only 
puts a stop to all this, but gives even greater comfort 
and quicker relief. 

No doubt the mere mention of these remedies has 
stirred up in your memory the recollection of scores of 
others, some of them, perhaps, explicable upon some 
curious ancestral or directly utilitarian ground, others 
of them the purest of freaks, with no apparent relation 



HOME DOCTORING 43 

to anything else in the heavens above or in the earth 
beneath. Some seem to depend for their virtue upon 
being outre and extraordinary as possible, such as the 
drinking of warm blood as a cure for consumption, the 
eating of a roasted mouse as a cure for rickets, the swal- 
lowing of a little pellet of cobwebs to stop the spitting 
of blood, the free application, internally or externally, 
of garlic, onions, assafoetida or ammonia for all sorts of 
disorders. 

Some of these have very curious and interesting his- 
tories into which space forbids us to enter. One, how- 
ever, has such a singular connection that I cannot for- 
bear to mention it, and that is, the great universal 
" blood purifier," clover tea. This has received a fresh 
notoriety of late years by being brought forward as a 
remedy for no less terrible a scourge than cancer. As 
usually made, it is as absolutely inert as an infusion of 
hay or corn husks, and can be drunk by the quart or 
the gallon without any danger whatever save that of 
drowning. It? sole standing as a remedy is a ritual, not 
to say ecclesiastic, one, due to the fact that the leaf of 
clover, containing three leaflets or "foils," like the 
shamrock of St. Patrick, has been taken for centuries 
as a representation of the Trinity, and hence endowed 
with healing virtues. It has an even older cryptic his- 
tory than this, but that is too long a story. 

Take them altogether, they are a cheerful, comfort- 
ing, comparatively harmless crew. Some of them are 
sufficiently poisonous to be a source of danger, but 
these are being gradually weeded out. Others have 
been and are yet used too indiscriminately and too 



44 COMMON DISEASES 

blindly. But the fittest only are surviving even among 
them. The oils were only dangerous if they were rubbed 
in too hard; the poultices were the only group which, 
perhaps, on the whole, did more harm than good. In 
fact, the chief danger of household medication is to be 
found in another direction, and that is the extent to 
which it may postpone the recognition and proper 
treatment of serious disease. 

But here, of course, the average man is in a quan- 
dary. There can be no question that fully one-half of 
all the disagreeable sensations of impending cold or ill- 
ness which one experiences will pass away completely 
under the influence of a hot drink and a good night's 
rest. Two thirds even of all distinct diseases which do 
not thus disappear will ultimately get well if nothing 
is done for them, though, of course, often at the cost of 
great increase of pain, danger and slowness of cure. 
Hence the basis for the confidence felt in home remedies 
— which equally underlies professional ones. 

Naturally, under our existing relations between 
physician and patient, any one hesitates to go to the 
expense of consulting a physician unless he is reasonably 
sure that it is really necessary. An immense amount of 
valuable time is often lost in this hesitation. 

A great help toward the solution of the difficulty 
would be the recasting of our system of medical attend- 
ance and making it by the year, instead of by the 
visit.. This was suggested some years ago by the 
writer and, as he showed, would involve not only no 
increase, but a positive saving of expense to the aver- 
age family or individual patient. For a very moderate 



HOME DOCTORING 45 

sum per capita a doctor could engage to take care of a 
certain family and render whatever medical services 
were necessary during the year. This could be made to 
include a yearly, or, better still, a semi-annual, inspec- 
tion of the house, business premises and schools occu- 
pied or attended by the members of the family, and a 
half-yearly or quarterly general overhauling of each 
individual, whether he seemed to need it or not. Then, 
when any one felt out of sorts, and one round of domes- 
tic remedies and a good night's rest failed to relieve, 
there would be felt no hesitation in consulting the phy- 
sician and having it decided in ten minutes whether 
anything serious be the matter, or whether the case 
might safely be left to Nature. 



CHAPTER III 

THE ADVANTAGES OF ADIPOSE 

IT is natural to desire to be different. Whatever we 
are, or have, we would like to be something else. 
The really desirable thing is always precisely what we 
have not got. Properly balanced, this instinct is one of 
the mainsprings of progress. A reasonable amount of 
discontent is wholesome, but an excess of it is the great- 
est murderer of happiness known. Nowhere is this 
tendency better exemplified than in the matter of our 
bodily proportions. The tall girl is quite sure that her 
giraffe-like proportions render her unduly conspicuous. 
The short man, in spite of his bantam-like brag and 
bluster, "that it is your small men, sir, that have made 
history," would give his ears to be tall. The thin wo- 
man compares her willowy outlines to a lath or a scant- 
ling, while the plump and comfortable maiden thinks 
of herself as a barrel or a flour-sack. So that we must 
be prepared to discount many of the complaints of the 
corpulent, of the wails of the well padded, as having 
little more substantial basis than this perverse tend- 
ency of human nature to hanker after the unattain- 
able, to insist on placing the Delectable Land just 
below the horizon, or, as the Kerry peasant puts it, 
"back of the Bey ant." 

In at least half the cases of self-styled obesity which 



THE ADVANTAGES OF ADIPOSE 47 

clamor for relief and sympathy, their fatness, like the 
Emersonian's Boston, is not a place, but a state of 
mind. Easily another twenty-five per cent are chiefly 
concerned over their increased generosity of outline 
on account of the real or imaginary loss of sylphlike 
grace and slender symmetry; and if they could be reas- 
sured upon this point would not be a pin the worse, and 
often many points better, for their increase in weight. 
Not more than twenty-five percent of those who bewail 
their amplitude of growth are in any serious way dis- 
abled or discomforted by it. Yet fully fifty per cent of 
the human race live in dread that they are or will some 
da}' become unwieldy, gross, "lubberly," "tubby," 
"pussy," "roly-poly," "mountains of fat," "human 
haystacks," or any one of the score of picturesque, 
metaphoric terms in which our vernacular is so fertile. 
To be "fat and scant o' breath" has been counted a 
reproach from the days of Falstaff, while "fatty" is as 
ancient and classic a term of derision as "Go up, thou 
bald-head." 

There can be no doubt that an overwhelming, en- 
cumbering excess of adipose is a real infirmity, little 
short of a calamity, and the sufferings of those who are 
saddled with it are pathetically genuine. Yet I seriously 
doubt whether any one of an average range of acquaint- 
ance could number among his total circle more indi- 
viduals who are afflicted in this way than could be 
counted on his ten fingers. Not more than five or ten 
persons in the thousand are distressingly and disa- 
blingly fat, and yet every one who begins to round out 
his curves and lay on flesh, be it ever so slightly, is 



48 COMMON DISEASES 

absolutely sure that he is destined to be one of those 
horrible examples. It is not so much what they are now 
that the corpulent complain of, as the dread they have 
of what they may grow into, as they get older. It is the 
calamities that never happen that turn our hair gray 
and grave the wrinkles. The plump have the same 
horror of even the mildest increase in weight that the 
Prohibitionist has of the first drink — for fear of what 
it may lead to. 

One would think that fatness was a disease, a deadly 
plague, which, when once it had got foothold in the 
system, would go steadily on to destroy it, and whose 
earliest appearance and slightest symptoms were a 
danger signal and a cause for alarm. Few things could 
be further from the physiological fact. Nine times out 
of ten it is a mark, not of disease, but of health. It is 
an indication that the system, by good management 
and good housekeeping, has brought its expenditures 
within its income and is able to lay by a little, against a 
rainy day . Fat is Nature's savings bank, a hoard which 
can be drawn upon in times of scarcity or of need. 
Fat is in the animal economy what starch is in the 
vegetable — a reserve fuel without which continuous 
and sustained activity would be impossible. Whenever 
Nature wishes to provide for the future she lays up fat 
or starch. It is no mere accident that nine tenths of 
the bulk of the seeds of plants and of the yolks of the 
eggs of birds and of animals is composed of these two 
substances — provisions for the life that is to come. 

For a long time fat was popularly regarded as a 
coarse, low-bred sort of substance, associated chiefly 



THE ADVANTAGES OF ADIPOSE 49 

with pigs and suet and whale blubber, and scientifically 
even as a low-grade tissue of small vitality, deposited 
chiefly beneath the skin as a combination of blanket 
and bacon for the body army. Now, however, the mi- 
croscope and laboratory have taught us to regard it as 
one of the most indispensable and important tissues of 
the entire body. Every tissue in the body, except the 
teeth and nails, has to have it in some form or propor- 
tion if it is to be kept in health. " Fat-headed " or " fat- 
witted" is a term of reproach, yet nearly half of the 
bulk of our boasted brain and nerves is made up of a 
delicate, fatty substance known as lecithin. So inti- 
mate a part of their structure is it that the well-known 
sleep-producing, anaesthetic effects of ether and chlo- 
roform are believed to be due to their affinity for the 
fatty substances of the nerve centres. Fat lubricates 
the movements of the muscles, pads over the promin- 
ences of the bones so that the skin can play smoothly 
over them without stretching or cracking; the eyeballs 
rotate upon a cushion of fat; not only are the hollows 
of our bones filled with it (yellow marrow), but the 
spongy portions of them are packed with a so-called 
red marrow, also largely fat, in which some of the most 
vital and important processes of blood formation are 
carried out. 

From a physiological point of view it is about as irra- 
tional to object to a fair amount, or even a moderate 
excess, of fat as it would be to too much muscle or too 
many brains, or, from a financial point of view, too 
much money in the bank. And in eight cases out of ton 
its accumulation will not go beyond comparatively 



50 COMMON DISEASES 

reasonable limits. Moreover, like money, where it can 
be accumulated, it can also be spent. Indeed, the pur- 
pose of its accumulation is for future spending, and this 
spending usually takes place within the lifetime of the 
individual. Nature is seldom so foolish as to be a miser 
and to accumulate for the mere pleasure of hoarding. 
In either case a margin is a good thing to have. You 
never have quite enough until you have a little too 
much. 

Granting that fat in perfectly healthy conditions 
constitutes ten per cent of the body weight; what are 
the causes that determine its accumulation in excess of 
this? In animals this is simplicity itself, and fattening 
can be produced at will by increasing their food supply, 
particularly in starchy or fatty substances, without 
increasing their exercise. In a state of nature a change 
of this sort occurs every fall, and is of obvious value as 
a preparation for the cold and probable food scarcity 
of winter. There is, however, nothing prophetic about 
it, as the old argument of design was wont to hold, for 
it simply depends upon the fact that the trees and 
plants that have formed the habit of maturing their 
seeds at this time of year will leave offspring that have 
a chance of surviving the winter, and by feeding upon 
these fruits, grains, and nuts the animal most selfishly 
grows fat. 

Our own species has almost completely lost this sea- 
sonal variation, its only survival being among farming 
populations, who, instead of laying on weight in the 
fall and losing it in the winter, gain weight in winter and 
lose it in spring. Animals in a state of nature and sav- 



THE ADVANTAGES OF ADIPOSE 51 

ages subsist usually in such a hand-to-mouth fashion 
and upon so narrow a dietetic margin that any marked 
increase of their food supply is promptly embraced as 
an opportunity of insuring themselves against the next 
famine by laying on fat. Civilized man, however, has 
had, for generations past, so comparatively equable a 
food supply the year around that he has, in large meas- 
ure, lost this tendency to respond promptly to in- 
creases in his food by laying on flesh. Unless his appe- 
tite be first improved by life or exercise in the open air, 
travel, or change of scene, an increase of food is more 
likely to make him bilious than to fatten him. In fact, 
the relation to-day between fatness and feeding is far 
less intimate than is usually supposed. Individual pe- 
culiarity, hereditary tendencies, and special habits of 
life are much more apt to be concerned in it than either 
quantity or quality of food. 

There is, however, one natural tendency to weight 
variation which still survives, and that is the inclina- 
tion to gain weight with increasing years, after adult 
stature has been reached. The average healthy, vigor- 
ous man or woman, after reaching and holding a com- 
paratively constant weight from the twenty -fifth year 
on for a decade or two, somewhere from the thirty- 
fifth to the fiftieth year is apt to show an inclination to 
put on from fifteen to thirty pounds of additional 
avoirdupois. 

This is a perfectly normal, natural tendency, roughly 
parallel with the animal habit of getting fat in the fall 
in preparation for winter. Fifteen or twenty pounds of 
adipose is as valuable a protection against the frosts of 



52 COMMON DISEASES 

old age as it would be against the blasts of Boreas. So 
far from this tendency being regarded as anything ab- 
normal or cause for uneasiness, it is, on the contrary, 
its absence which should cause us to worry. 

If it does not occur we had better look about for the 
reason why. The stout and comfortable middle-aged 
man or woman will stand the worry and strain of 
middle life, and have at least a ten to twenty per cent 
better chance of survival to a good old age than the 
thin, spare, and nervous one. Like every natural accu- 
mulation of adipose, it is stored up only to be spent, 
and this fifteen to thirty pounds increase in the fourth 
or fifth decade is almost certain to be lost again in the 
sixth or seventh. "The shrunk shank" and "lean and 
slipper'd pantaloon" are as characteristic marks of the 
sixth Age of Man as the "fair round belly, with good 
capon lin'd," is of the fifth. 

But it is not only in middle life that a fair degree of 
adipose — yes, of plain fatness — is both a sign of 
health and an asset for the future, but in earlier life as 
well. It is nearly twenty per cent safer to be ten 
pounds over than ten pounds under the normal or 
standard weight for your height at any age. The sta- 
tistics of our insurance companies years ago revealed 
the curious fact that, while those applicants for insur- 
ance, of consumptive family history who were ten 
pounds or more under weight showed a marked sus- 
ceptibility to the disease, those who were fortunate 
enough to be ten pounds or more over the standard 
weight showed, not only no higher susceptibility than 
the average of the community, but a slightly lower one. 



THE ADVANTAGES OF ADIPOSE 53 

In other words, an increase of ten pounds in weight had 
overbalanced the dangers of the hereditary tendency. 
One of our principal aims in the open-air treatment 
of consumption is to increase our patient's weight. 
When once he has fairly started to get fat we feel that 
half the first battle against the disease is over. Merely 
to find a young man or woman remarkably under 
weight for their height arouses a suspicion at once of 
possible tuberculosis. 

One of the most successful methods of treating neu- 
rasthenia and nervous bankruptcy, the celebrated Weir 
Mitchell treatment, consists chiefly of rest and over- 
feeding, and its object is to make the patient fat. So 
that a growth of healthy fat up to or even slightly in 
excess of twenty per cent of your former weight is a 
protection against disease, a buffer against the shocks, 
and a shield against the darts and pin-pricks of for- 
tune, a lubricator of all the frictions of life; it adds 
beauty to the beautiful and favor to the plain, and, in 
short, is an advantage in every way and a thing to be 
desired instead of dreaded, to be proud of instead of 
ashamed of. 

My advice, therefore, to the vast majority of those 
who are anxious to lose weight, to get thin, is like 
"Punch's" famous advice to those about to get mar- 
ried: "Don't." Your balance in the body bank may be 
a trifle unpoetic in the matter of waist-line, may show 
a regrettable preference for accumulating where the 
miners used to carry their gold, — under the belt, — 
but do not worry about it. You will have a good time 
spending it before very long, and most of the means 



54 COMMON DISEASES 

that you can adopt to get rid of it will do you far more 
harm than it ever will or can. Moreover, unlike the 
gold, it will float, and in the extreme emergency of 
shipwreck will act as a life-preserver instead of drag- 
ging you down to destruction, as so thrillingly de- 
scribed in the Shilling Shockers. 

You may rid yourself at once of the spectre that 
fatness is usually either a sign of disease or a cause of 
disease. Statements to this effect are abroad on every 
hand, dating back to a most respectable antiquity, one 
of them, indeed, attributed to the great Father of 
Medicine. If he ever said it it is simply another addi- 
tion to the numerous illustrations of the truth that 
great Jove himself sometimes nods. But in whatever 
mists of antiquity the saying may have started, it is 
little better than pure superstition, and its principal 
vogue at the present day is due to the shameless and 
unscrupulous exploitation of it in the columns of the 
newspapers by quacks and charlatans who have anti- 
fat remedies to sell. The business of these harpies, of 
course, is to fatten on the fears and superstitions of the 
people, and their jeremiads upon the dangers and ter- 
rors of fatness are as false as their claims to cure. The 
only weight their remedies can be relied upon to reduce 
is that of their victims' purse. 

The vast majority of diseases are marked by thin- 
ness and emaciation, not by fatness and increase in 
weight; and fatness is one of the rarest symptoms of 
disease, instead of the commonest. A, few conditions 
which diminish the power of the individual to take 
exercise, while at the same time the appetite and 



THE ADVANTAGES OF ADIPOSE 55 

powers of nutrition are not impaired, may be accom- 
panied by an increase in weight. A few other conditions 
in which there is an imperfect elimination of waste, or 
in which mildly narcotic poisons are either produced in 
the body or, like alcohol, introduced into it from with- 
out, may, by a perversion of the chemical activities of 
the body, result in a general choking, so to speak, of 
combustion and a consequent accumulation of flabby 
fat. But all these disease conditions put together 
would not account for five per cent of the instances of 
positive corpulence which we meet, and in none of them 
does the mere increase of fatty tissue constitute a seri- 
ous complication of the disease. There is another some- 
what larger group of diseases, chiefly those involving 
the heart or the kidneys, in which there is a marked in- 
crease in body weight and bulk, such as is commonly 
known as "bloating," but this is due, not to an accumu- 
lation of fat, healthy or unhealthy, but simply of wa- 
ter in the tissues, a genuine waterlogging of the body- 
hulk. 

Another ghastly delusion which has a wide circula- 
tion is that if ordinary healthy fat be allowed to go on 
accumulating it will finally "gather round the heart 
and choke you." This has about as much foundation 
as the equally widespread belief that if you lift up a 
guinea-pig by its tail its eyes will drop out. Fat around 
the heart and a fatty heart are as different as a horse- 
chestnut and a chestnut horse. A moderate increase of 
the normal adipose tissue upon the surface of the heart 
does occur in some cases of general obesity, but this 
does not interfere in any appreciable way with the 



56 COMMON DISEASES 

movements of the organ, except, to a slight degree, in 
the same way that it does those of the rest of the body 
— ■ by increasing its weight and bulk. The real fatty 
heart is a degeneration or decay of the heart muscle 
itself, in the course of which its muscular substance is 
turned into fat, much the same as the curd of cheese is 
turned into fat in the process of ripening. This, of 
course, is an exceedingly serious disease condition, 
but has no relation whatever to the fatness or thinness 
of the individual in whom it occurs; in fact, is quite as 
often found in thin and emaciated people as in stout 
and corpulent ones. 

But all this, while it may, to some degree, relieve 
their fears for the future and mitigate the horrors of 
their situation, is but scant comfort for the fifteen or 
twenty per cent of self-styled sufferers from obesity, 
who really have an accumulation of adipose excessive 
enough to interfere with both comfort and efficiency, 
and who can echo from the bottom of their hearts the 
aspiration of the poet : — 

"Oh! that this too, too solid flesh would melt ! " 

What can be done for them? That will depend entirely 
upon the cause of their unwelcome riches — their 
swollen fortunes. With fully half of them this will be 
found to be something for which they are not in the 
least responsible and which, also, is almost entirely 
beyond their control — a natural tendency to lay on 
flesh, to increase in weight, upon a diet and under con- 
ditions in which the average individual would remain 
thin and slender. We must frankly admit that we know 



THE ADVANTAGES OF ADIPOSE 57 

little or nothing of the nature of this tendency any 
more than we do of the similar ones to grow tall or 
short, to have blue or brown eyes, to be blond or bru- 
nette, except that, like all of these, it is very apt to be 
hereditary. 

A certain percentage of the members of some families, 
seldom more than twenty or thirty per cent, exhibit a 
well-marked tendency to grow stout and corpulent, 
some in young life, but more after a certain age has 
been reached. Our ability to modify this condition is 
almost as limited as our understanding of it. About 
all that can be done is to urge these unfortunate indi- 
viduals to keep up as active habits of exercise and out- 
door life as possible, to refrain from excess in the matter 
of sugar and starches, and, of course, avoid alcoholic 
beverages, and to encourage them to cultivate that 
cheerful tendency which, fortunately, usually accom- 
panies this bodily habit, and try to make the best of it. 
It is perfectly idle for them to starve themselves, to 
drain their tissues with drastic cathartics, to poison 
themselves with obesity cures, to sweat themselves into 
a hectic, or to walk in the sun or work in the gymnasium 
to the verge of exhaustion. Let them clear their minds 
of the dread that their fat is ever going to seriously 
injure them; rid themselves of the haunting sense that 
this accumulation is due to either gluttony or laziness, 
and hence is something in itself disgraceful ; eat a good 
variety of foods, particularly fresh vegetables, meat 
and acid fruits, and indulge in all the pleasurable kinds 
of exercise that they can find. 

In short, stop punishing themselves for what is not 



58 COMMON DISEASES 

their own fault, and worrying over a condition which 
they cannot cure and which will, probably, one day 
disappear of itself, and they will find their lot a toler- 
able and usually even an enjoyable one. A small group 
in whom fatness is due to some definite disease condi- 
tion, some perversion of the body metabolism, will 
have, of course, causations as varied as their diseases, 
and will each require individual treatment by a compe- 
tent physician. 

This leaves a considerable group of Falstaffs and 
"fair, fat, and forties," whose condition is due largely 
to the aggravation either of slight hereditary tenden- 
cies or of the normal weight increase of approaching 
middle life, by careless or bad habits on their part. The 
first and far the commonest cause of the trouble among 
these is the dropping of regular habits of exercise in the 
open air, such as is very apt to occur after the age of 
twenty-five in both men and women under modern 
conditions. Conventional and commercial influences 
have about equal weight. 

The boy who has completed his period of studies, of 
apprenticeship, and of experimentation, and settled 
down to his trade, his business, or his profession, is 
taught that it is beneath his dignity and will interfere 
with his reputation for steadiness and reliability in the 
community to continue his baseball, football, or tennis, 
and, except at annual or semi-annual intervals, his 
sport with rod, gun, and canoe. At the same time the 
settling down to regular office or work hours and 
the cares of business and his newly established fam- 
ily leave him little time or strength for these mere 



THE ADVANTAGES OF ADIPOSE 59 

amusements and luxuries, as they are commonly re- 
garded. 

Naturally he is very apt to do one of three things: 
to lose his appetite altogether and become dyspeptic, 
nervous, and restless, which is the worst; or, in some 
measure, to adjust himself to his new surroundings, 
moderate his appetite, accustom himself to bad air and 
too little of it, both day and night, and drop into a 
semi-narcotized, blind-horse-in-a-mill frame of body 
and mind, which is the common lot; or to hang on to his 
appetite and his enjoyments, only changing the latter 
from outdoor to indoor ones, and in consequence begin 
to get fat and bodily sluggish. This increase in weight, 
of course, makes him more disinclined for outdoor 
exertion, and whenever the eating of a reasonable, 
healthy amount of food, followed by no decent amount 
of exercise to burn it up, makes him feel bilious, he 
puts the whole blame of his discomfort either upon his 
fatness or the poor, innocent food, instead of his bad 
physical habits which have caused the whole trouble. 

In like manner the girl, even if she has been blessed 
with a mother sensible enough to let her grow up like a 
tomboy and do everything her brothers do, when she 
passes her seventeenth year begins to be preached and 
dinned at that real exercise and sports of all sorts are 
unladylike and unbecoming, and is taught to repress all 
her healthiest instincts for fear they may possibly 
be considered "bad form." About the time that this 
mental strait-jacket is being put on, a physical one of 
steel and whalebone is applied to her waist, her feet 
are cramped into pointed-toed, high-heeled absurdities 



60 COMMON DISEASES 

named shoes, her limbs are encumbered by a ridiculous 
profusion of crippling skirts, and she is fairly broken in 
to that condition of mental and bodily slavery to con- 
vention and precedent which will encumber the re- 
mainder of her life. No wonder women long to be 
emancipated — but they need other liberations besides 
the ballot. 

A little later in life another influence adds its weight. 
She is now married and settled for life, and she pro- 
ceeds to look the part. She will soon be gray and mid- 
dle-aged, she no longer has to look about for a husband, 
her children will accept her appearance as a matter of 
course; what is the use of pretending to be young and 
sprightly when you are forty and bound to be fat? 
Fortunately many of these absurdities are being swept 
out of our brains into the ash-barrel, where they belong. 
The present generation has largely emancipated itself, 
and the rising generation is growing up free from their 
stifling and benumbing influence, and, as a consequence, 
already women are no longer becoming fat and frump- 
ish at forty — no, nor old and useless at sixty. In 
another generation we shall all be young and active 
and happy until we die. 

Contrary to popular impression, and, indeed, to 
former medical teachings, positive laziness, actual glut- 
tony, or even over-eating have really very little to do 
with fatness. Fully one half of those who are exces- 
sively fat eat no more than the average, and many of 
them much less. There are occasionally errors in the 
quality and kind of food, mainly in the direction of 
taking too much starch or sugar. An excess of fat in 



THE ADVANTAGES OF ADIPOSE 61 

the diet is seldom to blame for obesity. Indeed, most 
of the rational diets for the reduction of obesity, in 
suitable cases, make fat an important factor because 
such small amounts of it will give the requisite amount 
of nutrition and fuel value and at the same time a 
sense of satisfaction to the appetite such as neither 
starches nor meats will give, except in much larger 
amounts. 

Finally, what is to be done for the cure of this condi- 
tion where it demands one? Remembering that fat in 
itself is in no way injurious, but rather a sign of health 
and a valuable store of reserve material for the body, 
the first principle to be laid down is that our aim 
should be not so much to get rid of fat, or reduce our 
weight, as to train ourselves to carry what we have 
with comfort and efficiency. The chief and, indeed, 
only safe remedy is vigorous, active, outdoor habits 
of life. As everywhere else, the best cure is prevention. 
Do not let yourself become fat, even at forty, and you 
will have little trouble; keep up your boyish and girlish 
sports and pleasures; plan your day's work so as to get 
from two to five miles' walk or its equivalent in some 
form of exercise every day and double that on Satur- 
day or Sunday (the apparent loss of time will repay you 
double in increased vigor and improved quality of your 
work) ; and even if you do tend to become a trifle more 
generous in your outline and ample in your girth 
after forty, you will never be conscious of it, except 
when you look in the glass. Many a man has had prac- 
tical illustration of this fact by going off on a long and 
arduous hunting or fishing trip in the north woods for 



62 COMMON DISEASES 

the purpose of reducing his weight. He comes back 
feeling fit for anything; all his shortness of breath has 
disappeared; he is good for twenty miles a day across 
the roughest country; his appetite never was better; his 
eye is bright and his head is clear; he has lost nearly 
three inches in waist girth and half an inch in the 
neck; yet when he steps on the scales, he not only has 
not lost an ounce of actual weight, but has gained ten 
pounds. He has simply distributed his weight better 
and built up the muscle to carry it with comfort. 

This should be the aim of most of our obesity suf- 
ferers. Only a small per cent, if they will throw off their 
tight boots and crippling clothing, will emancipate 
themselves from the slavery of the demands of society 
or of office hours, and live a vigorous, natural, whole- 
some life, but will find they will either secure an ap- 
preciable reduction in weight or such an improved 
distribution of it and increased strength and vigor as 
to be able to carry it about practically without discom- 
fort or inconvenience. A moderate system of empty- 
handed exercises in the indoor gymnasium, five to ten 
minutes' vigorous wind-milling night and morning just 
after the bath, including such exercises as bend the 
back, stretching to their utmost the muscles of their 
waist line, both of the sides, and of the abdomen, will 
do much to help. But violent spurts of overwork in a 
hot, stuffy gymnasium, or fierce, heart-breaking runs 
across the country, or violent attempts to rapidly re- 
duce flesh in a short time, are both dangerous in 
themselves, as tending to throw strain upon the heart 
which is already ageing and stiffening, and practically 






THE ADVANTAGES OF ADIPOSE 63 

useless in the long run, because they cannot be kept up 
beyond a temporary spurt, and as soon as they are 
dropped, the weight returns to its former level. 

There is no necessary connection whatever between 
leanness and efficiency and fat and clumsiness. Many 
of the most vigorous, energetic, and efficient of men 
exceed even Speaker Reed's standard of a gentleman 
— two hundred and fifty pounds. A stupid individual 
who grows stout does not add anything to his mental 
agility in the process; and the fat fool, in appearance, 
at least, has added an equal number of pounds to his 
folly. But that men or women alter notably either 
their abilities or their efficiency by adding thirty, forty, 
or even seventy pounds to their avoirdupois is a posi- 
tion which would be utterly untenable. 

One word as to the dangers of some of the methods 
proposed to cure — most of the patent ones, of course, 
are arrant, notorious frauds. A few of them really do 
"work" mainly by virtue of being or containing dan- 
gerous poisons which reduce the weight of the body 
much in the same way as would an attack of typhoid 
fever. The vast majority of them, however, are ridicu- 
lously ineffective, composed often of the simplest and 
cheapest of substances like common salt, baking-soda, 
flour, or chalk. Such of them as have acquired any 
reputation whatever depend largely for this upon the 
fact, already alluded to, that in nine tenths of all cases 
the accumulation of fat occurring in middle life disap- 
pears of its own accord in later life. 

Those who are so blest insist upon regarding it as a ca- 
lamity, and try all sorts of more or less absurd remedies 



64 COMMON DISEASES 

for its cure. They keep at it until the tide in the affairs 
of men is reached at which their fat begins to disappear, 
and then the last remedy which they happen to be tak- 
ing at the time gets the credit. 

Much the same may be said of most of the various 
modifications of diet which are advised for the reduc- 
tion of weight. The majority of them are harmless, 
but a few are dangerous to a marked degree. All of 
them, practically, are forms of starvation, more or less 
modified. If this process be kept within reasonable 
limits a certain amount of the body reserve can be 
drawn upon and burned, and the weight of the indi- 
vidual reduced without any particular damage to 
health or to efficiency. Such reductions, however, are 
not likely to be permanent, nor can the diet upon which 
they are produced usually be indefinitely persisted in 
without impairing nutrition and working-power. Fat 
is unlike a balance in a bank in one sense, that, as a rule, 
it can be drawn upon only in an emergency, such as 
illness, injury, or enforced starvation in famine. To 
attempt to produce a condition of artificial famine by 
reducing the diet will reduce the weight of the obese 
in a majority of cases, but it will often do so at the 
expense of both their health and their comfort. The 
amount that a man must eat depends upon the 
amount of work that he has to do. Like the steam en- 
gine, for every foot-pound of energy expended from 
five to ten pounds of energy must be generated in his 
furnace under his boiler. No matter how fat he may 
be, he cannot stint himself markedly of this amount for 
prolonged periods without injury. Starvation is a de- 



THE ADVANTAGES OF ADIPOSE 65 

cidedly dangerous game, and he who plays it must 
have either great skill or unusual luck to avoid injury 
in the long run. 

Most special diets recommended for the reduction 
of weight are merely starvation in disguise. The method 
of avoiding all kinds of liquid at meals simply means 
that by this method you choke your appetite at a 
much earlier period than you would if you accom- 
panied your meal with plenty of fluid. The other much- 
vaunted method, of eating only one dish at each meal 
and as much of that as you want, depends upon pre- 
cisely the same principle. Any single food, no matter 
how savory or attractive, palls upon the appetite and 
extinguishes it long before an adequate amount of food 
has been taken for the purpose of nutrition. Similarly, 
the trick of taking small amounts of food at frequent 
intervals cheats the appetite into a delusion of satisfac- 
tion with a totally inadequate amount of nutritive 
value. 

Most of these systems may be judged by their re- 
sults. If, while they are reducing weight, they produce 
sensations of restlessness, craving, irritability, and 
sleeplessness, they are doing the individual far more 
harm than the few extra pounds of harmless adipose 
which they are removing would ever do him. 

The danger of fat is not in the adipose tissue itself, 
but in the man or woman who carries it, and the 
absurd things they will do to get rid of it. 



CHAPTER IV 



DYSPEPSIA 



EVERYBODY knows, of course, that our Ameri- 
can digestion is the worst in the world. But we 
are beginning to discover, in these Darwinian days, 
that while what everybody feels is pretty likely to be 
right, what everybody knows is often apt not to be so. 
Our hearts are pretty likely to be right, but our heads, 
— the less said about them the better, and our stom- 
achs, — well, that remains to be seen. They certainly 
resemble our hearts much more than they do our heads. 
We are soundly convinced that we are a nation of 
dyspeptics. We were told that years ago by one Thomas 
Carlyle, and he ought to have known, for he had the 
worst case of it himself ever seen in captivity. In fact, 
he was one walking, animated indigestion, and incident- 
ally grew it on the usual food and favorite culture 
medium of dyspepsia, Scotch oatmeal. Talk of the 
scholars, theologians, and statesmen who were bred on 
that cheerful cereal, they were not one tenth as numer- 
ous as the dyspeptics it produced. In fact, not a little 
of the dourness and Calvinism of Scotch scholars and 
divines was born of it, and the melancholy induced by 
it could only be neutralized by the fiery exhilaration of 
the other brand of extract of cereal for which Scotland 
is famous. Was n't it Bishop Vincent who said, "Most 



DYSPEPSIA 67 

people think themselves religious when they 're only 
bilious"? 

Practically every visitor who has come to our shores 
since the time of Dickens has echoed this verdict upon 
the national stomach, and the fewer weeks he stayed 
the more positive was his dictum, until we have come 
meekly to accept it as an article of faith, amounting 
almost to an axiom, that our national gastronomic 
horse-power is exceedingly and distressingly low. We 
have never been reckoned lacking in the saving virtue of 
a fairly good opinion of ourselves, yet we meekly listen 
to Hans Breitmann boasting of his placidity, his self- 
control, and breadth of beam, based on his matchless 
digestion, or to Timothy Tugmutton pluming himself 
upon his ruddy complexion, unhurried movements, and 
peaceful length of days as contrasted with our haggard 
nervousness and life-shortening hustle and excitability 
due to his eupepsia and our dyspepsia, respectively. 

It furnishes one of the most beautiful illustrations of 
how little what a man believes about his health has to do 
with his actual physical condition, that in spite of our 
implicit and pessimistic belief that our digestions had 
gone to the dogs and our nerves were rapidly following 
their example, we have made not only themost astonish- 
ing national growth, in our century of dyspepsia and 
neurasthenia, that ever was known in the world's his- 
tory, but that the native-born American of the second 
or third generation exceeds at all ages, from infancy 
upward, in height, weight, and chest girth, any other 
nation or race on the face of the globe. Instead of our 
neurasthenic and dyspeptic population becoming an 



68 COMMON DISEASES 

easy prey to the eupeptic and vigorous nations of 
Europe, the bitterest wail which goes up from London 
to Constantinople and from Naples to Stockholm is that 
Europe is becoming "Americanized" in business, in 
transportation, and even in politics and social life and 
forms of government. 

As for nervousness and lack of judgment and national 
hysteria, if anything can be found to match the hys- 
tero-epilepsy of even the most cultured and impassive 
classes of the English people over the rank bugaboo of 
the "German Invasion," or the riotous excitement and 
mediaeval racehatreds of France over the Dreyfus case, 
or the panic-stricken terror of the German financiers 
over the Agadir incident and its complications, it 
would be hard to discover it in the last half century of 
American history. We can really begin to plume our- 
selves on being one of the coolest and least excitable 
nations of modern times, and can congratulate our- 
selves upon having not merely one of the oldest, but the 
stablest government in the civilized world — if that be 
altogether a matter of congratulation. 

American dyspepsia, judging by its results, would 
seem to be a pretty good remedy to have in the family 
in case of sickness. It is not unlike Grant's whiskey, in 
the classic story of some meddlesome busybodies who 
kept bringing accounts to Lincoln, during the famous 
Vicksburg campaign, of Grant's alleged drunkenness 
and addiction to liquor. He stood it as long as he could, 
and finally burst out with, "I wish I could get a jug of 
Grant's whiskey and send it to some of the other gener- 
als on this side of the mountains." 



DYSPEPSIA 69 

As a matter of fact, American dyspepsia, like many 
national traits observed by new-come travelers, was 
largely imaginary and due chiefly to the freedom and 
frankness and lack of reserve with which the free-born 
American of those days was willing to discuss his symp- 
toms in public. The German or Englishman suffers 
just as much from it, only it is against his social and 
moral code to eviscerate himself in public. But just 
wait until he gets you into a secluded corner of the 
smoking room, and breaks through the frozen crust 
which surrounds him, and he will talk to you by the 
hour about his private indigestion. 

Another thing which helped to start the fairy tale — 
and fairy tales need only a start to be assured of im- 
mortality — was the astonishing, and to the tender- 
foot, appalling habit of profuse and accurate expecto- 
ration which marked the untamed free-born American 
citizen of that earlier day. The period at which a boy 
was able to "spit over his chin" marked his emergence 
into manhood, and expert operators were as proud of 
the accuracy of their aim at any given spittoon, up to 
twenty feet, as they were of their marksmanship with 
the famous Kentucky deer rifle. Surely a stomach 
which was being robbed of pints of the secretion of its 
salivary glands daily, could not possibly be in anything 
like a healthy and prosperous condition. The inevit- 
able conclusion was never more crisply put than by 
the brusque and immortal Dr. John Abernethy, who, 
when consulted by an attache of the American lega- 
tion in London about his dyspepsia, summed up as his 
final advice, "Keep for the digestion of your food the 



70 COMMON DISEASES 

saliva which you waste upon your carpets, and you 
will be well, Sir." 

As a matter of fact, there is nothing the matter with 
the American stomach. On the contrary, it does its 
work better than any other stomach in the world, be- 
cause it is better fed, supplied at more regular intervals 
with larger quantities of more nutritious foods than any 
other national stomach in the world. The digestion, 
like the affection of the Queen Mother in Hamlet, 
" grows by what it feeds on." The most serious malady 
that the stomach can suffer from is emptiness, and that, 
thank Heaven ! the American stomach has never expe- 
rienced and never will — no matter whom it has to eat 
to fill itself. 

The position of the stomach in the body politic is 
really one of remarkable ancestral dignity, and present 
responsibility. Yet we treat it as if it were a scullery 
maid. It is the Cinderella of the body household, sit- 
ting in the half-light of the basement kitchen, down in 
the cellar among the greasy pots and pans, loaded with 
all the dirty work of the house, while its idle step-sisters, 
the lips and the eyelids and the hair, go forth to flaunt 
themselves in the sunshine and dance under the chan- 
deliers. It is not even considered polite to mention its 
name in public except when we want to complain of it 
or berate it for its shortcomings. 

Yet if there be any place in the body which is the 
proper and logical seat of the soul, it is the stomach. 
When we lay our hand upon our heart in sign of ut- 
most loyalty and devotion, we are really laying it upon 
the cardiac end of our stomach — but, of course, 



DYSPEPSIA 71 

"heart," sounds better and more poetical. When we 
are cut to the heart by ingratitude or treason, the 
anatomical structures which are really lacerated are the 
terminal filaments of the solar plexus in the mucous 
membrane of the posterior wall of the stomach. And 
every child knows where the famous knock-out, or 
solar plexus, blow of our most popular and intellectual 
form of debating is landed. A man may be cross-eyed 
or bow-legged, or asthmatic, or half paralyzed, or 
racked with all the agonies of rheumatism or neuralgia, 
or half eaten alive by cancer, and still be a man; but 
the noblest hero or most sublime saint in the world is 
no better than a wisp of wet dish-rag when he is sick 
at his stomach. The martyr may sing songs of lofty 
devotion while being burned at the stake, but fancy 
any one directing a battle or writing a poem when he 
was sea-sick! 

Eyes, ears, hands, and feet are parts of us, but they 
belong to us, not we to them. We speak, and they 
obey. But the stomach is "us," the self of our inmost 
self, and when it speaks it is with the still, small voice 
that compels obedience. And why should n't it? For 
all things in the realm of nature there is a reason. 

From a biologic and dynamic point of view, the 
stomach is far and away our most important and most 
fundamental organ. Biologically, it is the oldest organ 
and best friend we have. Dynamically , it is the socket 
into which is inserted the plug of the wire that connects 
us with the world dynamo, with the power-house of the 
universe. Physically considered, we are simply pro- 
teid sponges, in human shape, filled with sea water, 



72 COMMON DISEASES 

galvanized into life by the great sun currents which 
flow into us through our sole and only port of entry for 
the energy of the outside world, the stomach. If we 
prefer to regard ourselves as rosy clouds of water mist, 
shot through and glowing with the sunlight of the uni- 
verse, called up by it from the blue depths of the sea 
of being in the pearly dawn of our life, and sinking 
peacefully to rest in it again in the crimson sunset or 
purple twilight of our little day, — well, you pay your 
money and you take your choice, "It's all the same 
in — chemistry." 

Why is a stomach, anyway? Listen, and you shall 
hear. We were not always thus. In the happy child- 
hood of the world, when life first began, ere Nature tried 
her 'prentice hand on man, we really lived the Simple 
Life — though we never will again : it takes too much 
time. We floated happy and careless in the tepid, 
brackish waters of the marshy lagoons, brainless, arm- 
less, legless, careless little " gobs " of clear animal jelly, 
more like tiny gumdrops without the sugar than any- 
thing else, sucking in nourishment at every pore. We 
did not worry about our daily bread, because it was 
supplied to us fresh and fresh every ten minutes, nor 
were we aware that the world owed us a living, since 
we never had the slightest difficulty in collecting it. We 
toiled not, but we did occasionally spin — round and 
round, by means of the " lashers " on our surface. 

We were not quite so simple as we looked. Though 
we had no eyes, it was because we were all eye and 
could perceive the light waves with every pin-point of 
our surface, likewise the sound waves, so that we were 



DYSPEPSIA 73 

literally, as we have often been metaphorically, accused 
of being, at a later stage of our development, — all 
eyes and ears. We had no legs, because we were able 
to make a leg on ten minutes' notice at any time by 
simply shoving out one of our corners into a tentacle as 
needed. 

We had no stomach, because we were all stomach; 
and our method of engulfing food was to simply sidle 
up to it, half pour, half curl ourselves affectionately 
round it, suck out of it what might be digestible, and 
then gently pour away from it again, leaving the insolu- 
ble remnants outside the breastworks. No chance for 
indigestion, for colic, for appendicitis! What would 
we not give to return to such happy and dignified sim- 
plicity now-a-days ! We were like the angels in Heaven, 
neither digesting nor indigesting our food, neither mar- 
rying nor giving in marriage. 

As far as our knowledge of evil or of suffering was 
concerned, we were in the position of the rural justice 
of the peace who had just been elected to office and 
was making his inaugural address. He wound up his 
remarks with the declaration that, inasmuch as it had 
come to his ears that there had been much complaint 
and accusation of partiality in the judgments formerly 
rendered in that court under his predecessor, he wished 
it clearly and distinctly understood, once and for all, 
that during his administration neither partiality nor 
impartiality would be displayed in that court! 

By and by it occurred to our gumdrop ancestor that 
there was virtue in the division of labor, and beginning 
with the most important things first, he set aside a 



74 COMMON DISEASES 

little area of his surface exclusively for purposes of 
engulfing and sucking the nutrition out of food scraps. 
In order to hold the food in contact with itself, this 
little area first hollowed itself into a dimple and later 
into a pouch, and behold ! the father of all organs and 
creator of man, the stomach, was born. 

As there was no way of getting rid of any remnants 
which could not be melted save by the rather clumsy 
and troublesome process of the pouch turning itself 
inside out, it soon became desirable to have some sort 
of inspection service established at the mouth of the 
pouch, and as most things which are fit to eat smell 
good — even to this day — a couple of little spots in 
the skin of the creature, just above the mouth, began 
to specialize in the discrimination of odors and sank 
into pits, and thus formed the nostrils and olfactory 
nerves. At the same time a mechanism for barring out 
that which was bad became necessary, the band of 
living stuff round the mouth turned itself into a ring 
of muscle, and the lips and jaws were born. To control 
the small pits grew up a little nerve knot, the olfactory, 
and to direct the mouth ring, another. Then from the 
union of these two, in order that they might work in 
harmony, was born a most illustrious child, our lordly 
brain. 

Next came the necessity of testing the food by sense 
of sight and seeing the dangers into which the body 
was led in pursuit of it, and two other little spots upon 
the surface above the mouth specialized on the light 
waves, and sinking into the body mass, became the 
eyes and the optic nerves. A little later the sense of 



DYSPEPSIA 75 

hearing was demanded for the 1 same purpose, and two 
other little sensitive patches on the skin devoted them- 
selves to the sound waves, shut themselves off and sank 
into the deepest parts of the head end of the creature 
and became the ears and the auditory nerves. All these 
were successively coupled up with the nose- jaw com- 
bination. 

The mouth end of the creature became the head 
end because it was most frequently poked into danger. 
Then a department of superintendence of all these 
different and occasionally conflicting outlook depart- 
ments was demanded, and the cerebral hemispheres or 
upper brain budded out. The hemispheres have since 
become two thirds of the brain total, but to this day 
the basal structure and main stem of the most huge and 
complicated human brain are composed of, first and 
frontmost, a pair of nose lobes, and a pair of jaw lobes, 
or ganglia, then a pair of eye lobes, then the ear lobes, 
and finally, the balancing lobes or cerebellum. 

The stomach literally made the brain for its own pur- 
poses and use, and from a biological point of view the 
most highly specialized animal creature,, man himself, 
is nothing but a cast of his own stomach. It is no won- 
der that we think much about our stomach and squan- 
der gallons of printer's ink and untold cyclones of 
breath over our favorite foods and schemes of dieting, 
and what will agree with us, and gloat over the vaga- 
ries of our digestion. As a man digesteth in his stomach, 
so is he. 

It is not always safe to judge either by appearances 
or even by feelings. Though we hear more talk about 



76 COMMON DISEASES 

indigestion and of distress after eating and of "misery " 
in the epigastric region, than of any other evil that 
flesh is heir to, actual, definite, tangible disease of the 
stomach is one of the rarest of all maladies. Our stom- 
ach is not only our oldest organ, but our most reliable, 
our most resistant and our best behaved. Nearly half 
the discomforts and disturbances which we put down 
as diseases of the stomach are really unselfish efforts 
which it is making to protect the entire body in general 
or other organs in particular. 

Nine tenths of all forms of so-called indigestion are 
not due to the condition of the stomach at all, but are 
caused by influences operating in other parts of the 
food tube, or even in entirely separate and foreign parts 
of the body, miles away from it, physiologically speak- 
ing. To attempt to cure indigestion, dyspepsia, and 
discomfort after eating by dieting, or by methods of 
treatment directed to the stomach alone, is absurd and 
irrational. The reason why the stomach apparently 
suffers so much is on account of its unselfish devotion 
to the large family of children which it has produced 
and reared, namely, the rest of the organs of the body. 
Metaphorically speaking, its "heart is too big for its 
body," and that's what gets it into trouble. 

It is not by accident that the stomach lies at the 
geographical centre of our personal universe, at the 
intersection of our axis and our equator, as it were. 
Despised and half ostracized as it is, it is still emphati- 
cally "the works" of the body, has more questions re- 
ferred to it for settlement than any other organ in the 
body, more messages passing through it, and gives far 



DYSPEPSIA 77 

more orders to the haughty brain than it takes from it. 
Every emotion, every feeling that affects the body is 
reflected in the stomach as in a looking-glass, and vice 
versa, the states of our digestion affect our mental and 
emotional states more than any other influence of the 
world. We may think with our brains, but we decide 
with our stomachs, and two thirds of the lofty emo- 
tions which thrill our bosoms and glow in our hearts, as 
we fondly imagine, are really vibrations in the plexus of 
Auerbach just under our gastric mucosa. When our 
"bosoms swell" it is usually with gas in the stomach or 
with wind in the lungs. When we remember that it 
mothers and fusses over all the rest of the body like a 
hen with one duckling, in addition to digesting all the 
horrible messes and choice collections of junk and trash 
which we shovel into it in the shape of food, is it any 
wonder that it grumbles pretty often or even goes on a 
strike occasionally? 

The most distinguishing characteristic of the stom- 
ach after its wonderful vigor and its efficiency is its 
extreme good nature. Every organ in the body and 
every faculty in the mind can come to it with its 
troubles and receive its sympathy and assistance. It is 
the mouthpiece, the spokesman for every disaffection 
in the body and sympathizes with every grievance and 
insult from Welsh rarebits to disappointments in love. 

The first and most frequent danger signal of the 
body is pain, but the next and far more arresting and 
fundamental is nausea. We hear of the massacre of 
women and babies by Indians and it turns us sick and 
faint; the end of a log that we are handling slips and 



78 COMMON DISEASES 

crushes one of our toes, and we sit down hurriedly, 
white and trembling and nauseated; we stumble over 
a dead body in a dark hallway or smell the heavy, 
sickly-sweet odor of blood, and we are instantly sick at 
our stomachs; we are knocked down and stunned by a 
blow on the head, and the moment we come to, we 
begin vomiting furiously ; we hear a tale of tragedy and 
suffering, and our "bowels yearn" and our diaphragm 
vibrates tremulously. 

Why should the stomach take such an extraordinary 
and irrepressible interest in all these troubles which 
concern it not in the least and in which its well-meant 
attempts at consolation are not only useless but a 
source of further embarrassment and distress? It is 
one of the most curious problems of biology. The only 
explanation that can be offered that has even a show 
of reasonableness is that the tendency is ancestral 
and a part of what may be termed the memory of our 
tissues. 

The stomach being, as we have seen, our earliest 
and oldest organ and our chief port of communication 
with the outside world, our most serious primitive dis- 
turbances were naturally digestive ones from poisonous 
or improper food. Obviously, when we were all stom- 
ach the only pain or malady that we could suffer from 
was stomach-ache. And the quickest and most alpha- 
betic method of relieving it was to empty the stomach, 
so that the quaint and childishly illogical habit still 
clings to us, and we attempt to relieve our headaches, 
our heartaches and the wounds to our vanity or self- 
esteem by the old-fashioned method which so often 



DYSPEPSIA 79 

and so effectively " cleanses the stuffed bosom of its 
perilous stuff." 

The fact remains that whenever we are at our wits' 
end and can't think of anything else to do, we follow 
the old whist rule, "when in doubt play trumps" — 
and play Jonah. 

The other explanation is much more prosaic and 
matter of fact and therefore probably more likely to be 
correct. That is that the stomach alone of the entire 
ten yards or more of the food tube has any nerves con- 
necting it directly with the brain, all the rest of the 
intestines being supplied by a net- work, known as the 
sympathetic nerve system, which only indirectly and 
in a roundabout way, through the spinal cord, con- 
nects it with the centre. The stomach, therefore, being 
the only part of the food tube which is, strictly speak- 
ing, able to feel, it becomes the mouthpiece, or from 
another point of view, the scapegoat for the entire ali- 
mentary canal. As a matter of fact, many, if not most 
of the distresses which we term crudely stomach-ache 
or pain in the stomach are really situated in the coils of 
the intestine and not in the stomach itself at all. It is 
also established as a matter of oft-tested medical and 
surgical experience that the two most sensitive struc- 
tures in the body are the skin and the stomach. When 
the surgeon has cut through the skin, the most painful 
part of an abdominal operation is over, until he comes 
to touch the surface of the stomach. 

What then are the causes of that most familiar and 
frequent disturbance — after headache — which the 
human mechanism suffers from, indigestion or dvs- 



80 COMMON DISEASES 

pepsia? Though indigestion is Latin and dyspepsia is 
Greek for one and the same discomfort, it is well for 
practical purposes to make a distinction between the 
two terms, a distinction based merely upon their dura- 
tion and persistence. As a mere rule-of -thumb distinc- 
tion for purposes of practical convenience we term 
those gastric disturbances which occur fairly promptly 
after eating and disappear as soon as the particular 
food swallowed has been disposed of, as indigestion, 
while those forms of disturbance which have no special 
relation to meal hours and which either persist or recur 
at fairly frequent intervals, regardless of the kind or 
amount of food taken, we term dyspepsia. Indigestion, 
in short, is an accident, dyspepsia a habit. 

The distinction, crude though it be, is of great 
practical value, because it corresponds pretty closely 
to a wide difference in causation. The vast majority 
of attacks of indigestion are due, as might be expected, 
to the food eaten and may be cured by getting rid of 
the offending meal, and prevented by greater care and 
cleanliness and more rigid inspection of food, or per- 
haps the avoidance of the particular thing which dis- 
agrees. Obviously, there may be as many different 
causes for indigestion as there are qualities and kinds 
of food, but fortunately, the problem is slowly but 
steadily simplifying itself in these later years in a some- 
what unexpected manner. Up to twenty -five or thirty 
years ago, it was generally believed in both popular 
and medical systems of dieting that there were great 
and serious differences in digestibility and wholesome- 
ness between different kinds of food; that one food was 



DYSPEPSIA 81 

suited to a particular age and sex while another equally 
nutritious food was utterly unsuited, and that we had 
to be extremely careful not merely of what we ate even 
of perfectly wholesome foods, but also of the combina- 
tions in which we devoured them. Now, however, we 
are practically agreed, with the exception of a few 
dyspeptic eccentrics, that the only really important 
difference between foods is in their fuel value, and that 
the healthy stomach ought to be, and as a matter of 
fact is, abundantly able to digest at least ninety per 
cent of all the dishes placed upon our tables, providing 
that these contain adequate fuel value or calories, and 
are not inordinately bulky or fibrous. If a stomach 
cannot digest pork, for instance, the fault is not with 
the pork, but with the stomach, and its possessor ought 
to be ashamed of it, or rather of his bad habits of living 
which have brought him into such a weak and enfee- 
bled condition. 

In fact, such is our biological confidence in the 
stomach that our advice in regard to kinds of food is 
nearly that of the archbishop of the Middle Ages, who, 
when his soldiers were about to massacre a large con- 
gregation of heretics in his diocese, was asked what 
should be done to spare a considerable number of the 
faithful who had come to the meeting out of sheer 
curiosity. He replied, devoutly," Kill all. God will rec- 
ognize his own." Our twentieth century dietetic advice 
is to eat everything in reason, and trust the stomach. 

"But," says some one at once, "why then do foods 
disagree with us, as every one has had bitter and con- 
vincing evidence that they do?" Chiefly for two rea- 



82 COMMON DISEASES 

sons, — one great and almost all-embracing and the 
other very small. The first and far commonest and 
most important is that foods, when they are eaten, are 
in various stages of putrefaction or decay, or what is 
colloquially termed bad or spoiled. The second and far 
minor reason is that certain individuals have especial 
susceptibility or idiosyncrasies toward certain articles 
of food which are perfectly wholesome to all the rest of 
the community. It is not too much to say that nine 
tenths of all our cases of acute indigestion, acute 
gastritis, or gastric catarrh or colic or biliousness or 
diarrhoea, to say nothing of cholera nostra, dysentery, 
and typhoid fever are due not to the kind or amount or 
combinations of food eaten but simply and solely to its 
decayed, fermented, or putrefied condition. In fact, a 
large share of our most acute attacks of indigestion 
and of bowel disturbances are due to the multiplication 
in our own alimentary canal of bacteria and other 
germs or parasites introduced in the food which we 
have swallowed, and most of our attacks even of so- 
called food poisoning or ptomaine poisoning are due 
not so much to poisonous substances already formed in 
the foods, though these may be dangerous enough, but 
to the further multiplication and growth in our stom- 
achs and intestines of the bacteria which have pro- 
duced these putrefactions or spoilings. In fine, three 
fourths of our indigestion is due not to the stomach nor 
to the kind or amount of food eaten but to our careless- 
ness, stupidity, or ignorance in eating filth and poison 
in place of food. Incessant watchfulness and an in- 
tense, vivid, and wide-awake horror of dirt or every 



DYSPEPSIA 83 

appearance thereof in our foods, in our kitchens, and 
upon our tables will cure by preventing nine tenths of 
all attacks of indigestion. 

It was not by accident that Nature made our sense 
of smell the first and most fundamental of our senses, 
and it still remains to this day. Nothing will carry us 
back to the happy days of our childhood like the fra- 
grance of new-mown hay or the scent of wild-grape blos- 
soms along dusky, moonlit, woodland roads. If we 
would submit to the judgment of that most prominent 
and important of our features, the nose, every mouth- 
ful of food before we swallowed it, and every breath of 
air before we drew it into our lungs, and acted promptly 
on its judgment, we should avoid at least half of all the 
evils that the flesh is heir to, either gastric, intestinal, 
or pulmonary. Eternal sniffing is the price of health. 
Swallow only that which smells good and tastes good, 
and unhesitatingly reject all that does not, no matter 
where you are. Keep on until you feel that you have 
enough, and you may trust the stomach to do the rest. 
This is the only "sure cure" for indigestion. 

The other cause of indigestion, individual suscepti- 
bility, though far, far rarer, is at times exceedingly 
troublesome because it seems so unreasonable. "Why, 
under Heaven," protests the sufferer, "should any- 
thing that tastes as good as strawberries and is per- 
fectly wholesome and right for everybody else make 
my tongue swell, or my stomach burn, or my skin 
break out all over in hives? It is ridiculous! It is n't 
fair, and I won't stand it!" But unfortunately facts 
are stubborn things, and all that can be said in such 



84 COMMON DISEASES 

cases is what was said by the oldest mother in Israel in 
the cannibal village in the South Sea Islands when 
they were cooking the missionary and his cork leg 
would float up to the top of the kettle, "Some pork 
will bile that way." The susceptibility exists and there 
is no use arguing or fighting against it, although I 
would not advise anybody to give up strawberries 
short of at least twenty trials under every possible 
variety of experimental condition. If after careful and 
intelligent testing you find to your own satisfaction 
that strawberries or cherries or bananas or oranges or 
clams or oysters or lobsters or cucumbers or melons or 
eggs or mutton or onions or cabbage or tea or coffee 
positively do not agree with you, just let them alone. 
There are plenty of other good things left. 

The one thing that you must not do is to run 
amuck and start a crusade against the further use of 
these harmless and wholesome articles of diet by the 
rest of the world just because they do not happen to 
agree with you. Because you are bilious shall there be 
no more cakes and ale? Three fourths of the food fads 
of the world are started by crooks and cranks and sup- 
ported by invalids. It may usually be said with truth 
about the particular fons et origo mali, whether pork 
or sugar or red meat or salt or coffee, what was said 
by the French cynic about alcohol, that it certainly 
was a powerful stimulant, for it excited those who 
did n't take it almost as much as those who did. If 
your stomach or your head or your liver is too weak 
to stand any one of these things, for Heaven's sake 
don't brag of your defect in public. 



DYSPEPSIA 85 

So far from indigestion being in any sense a modern 
malady, it is one of the oldest in history, and instead 
of increasing, it is rapidly and notably diminishing and 
becoming rarer under civilization. 

We have a cynical old proverb that God made food, 
but the devil made cooks, and many other like ones to 
the same effect, and we denounce the cooking stove 
and the frying pan as one of the causes of modern 
degeneracy, but we forget that they both perform one 
service of incalculable value and that is that they kill 
the bugs in the food before it gets into our stomachs. 
This service outweighs tenfold any trifling harm that 
may have been done to our digestions. 

Indeed, unexpected as it may seem, this was proba- 
bly one of the primal causes for the application of fire 
to food and the invention of the art of cooking. The 
lower down we go in the scale of civilization, the more 
frequent and furious and fatal become attacks of in- 
digestion and diarrhoea, due to the eating of poison- 
ous or putrefied food. 

We make a terrible fuss about a tape worm when we 
happen to have one now-a-days, but even within the 
memory of the present generation they have become 
from a relatively common inmate one of the rarest 
inhabitants of our alimentary canals, and the quack 
doctors who go about selling vermifuges will pay as 
much as twenty-five or even fifty dollars for a first- 
class twenty-foot specimen to exhibit as one of their 
trophies to the gaping crowds. 

Most savages and semi-barbarous people have from 
one to two tape worms and a couple of score of round 



86 COMMON DISEASES 

worms, and a small zoological garden of other assorted 
kinds of wrigglers as regular parlor boarders, and in 
case of doubt as to the precise tribe to which a given 
Akka or Batwa belongs, the particular species of in- 
testinal parasite which inhabits him can be relied upon 
as a valuable means of identification. Then we talk 
with bated breath and horror of a few score cases of 
trichinae a year in our ninety millions of inhabitants. 

No wonder that sanitarians are insisting upon food 
inspection, and again Food Inspection, and always 
FOOD INSPECTION, as the most important and fun- 
damental step in our campaign for health. It is not the 
length of time that even perishable foods are kept that 
makes them really dangerous for human consumption, 
it is the filthy, careless, ignorant way in which they 
have been sprinkled with decaying fertilizer, exposed to 
the dust of the streets, which is chiefly powdered horse 
manure, crawled over by flies which have come from 
every garbage can and refuse heap and privy in the 
neighborhood, handled by diseased hands or sprinkled 
with water containing typhoid or summer dysentery 
germs. If we keep our food clean, just clean, surgically 
clean, we shall cut out three fourths, yes nine tenths, 
of all our disturbances of the digestion at one stroke. 

So permanent and almost exclusive a part do bugs 
of one sort or another play in most attacks of indiges- 
tion, that it is no longer considered necessary or even 
advisable to discontinue taking food, providing that 
food be clean and sound, until the attack has entirely 
subsided. Starvation is no cure; seldom even a 
remedy. Indeed, the very time the body most needs 



DYSPEPSIA 87 

an abundant supply of wholesome, digestible food will 
be found to be when it is engaged in fighting desper- 
ately against an attack of deadly germs introduced in 
some rotting meat or decaying vegetable. And we not 
only feed fevers, but we feed ptomaine poisonings and 
attacks of diarrhoea, and a liberal dose of sound, 
wholesome food is often one of the best intestinal 
antiseptics. 

The popular belief that savages in a state of nature 
have perfect digestions, irreproachable teeth, and are 
models of physical vigor, and perfect generally, is the 
purest of fairy tales, and has not the shadow of respect- 
able evidence to support it, barely more than the simi- 
lar delusion that our ancestors of a hundred or two 
hundred years ago were taller, stronger, and more 
eupeptic than we are. All through savagery, through 
barbarism and the lower half of civilization, famines 
were of as frequent occurrence as bank panics are now, 
and coarse, filthy, half putrid food was ravenously de- 
voured for at least three or four months out of each 
year by seven tenths of the people, with a perfectly 
enormous death rate from gastric and intestinal dis- 
eases. 

As recently as two hundred and fifty years ago 
scurvy, a disease due solely to eating half-putrid salt 
meat and fish and spoiled flour and meal, and the 
absence of fresh vegetables and fresh fruit, raged in all 
the navies of Europe and devastated scores of inland 
country districts as well. 

Three great factors contribute most of all to indi- 
gestion, and what we may term elementary ill health: 



88 COMMON DISEASES 

scarcity of food, particularly at certain seasons of the 
year, and its corollary, being compelled to use decaying 
or spoiled or badly preserved or poor food, and third, 
monotony of diet with insufficient variety, so that the 
three great kinds of foodstuffs, meats, starch-sugars, 
and fats cannot be obtained in their proper proportions. 

All of these the progress of civilization has wiped out, 
or is wiping out one after another, and our modern 
markets with their abundant supply of every imagin- 
able variety of food, animal and vegetable, fish and 
flesh, fowl and "good red herring " the whole year 
round, the introduction of preserves and of canned 
goods, made possible by the discovery of sugar, and 
the permanent supply of fresh vegetables and salads 
and fresh fruits the whole year round, by improved 
methods of culture and rapid means of communication, 
together with the increase of wages which has placed 
all these blessings within the reach of the working 
class, — the backbone of the community, — have 
made the twentieth -century stomach the best in the 
world, and the twentieth-century man the tallest, 
strongest, longest-lived, and most efficient human 
machine that the sun has ever yet shone on. 

Now, what is to be said as to those permanent, 
habitual, chronic disturbances of the digestion, known 
as dyspepsia? First and most important of all, that it 
is idle to look for the cause of them, nine times out of 
ten, in the stomach or even in the food. The only ways 
in which foods can cause chronic dj^spepsia is by being 
chronically insufficient in quantity or poor in quality, or 
monotonous in kind. In fact, the best advice which 



DYSPEPSIA 89 

can be given in one sentence to the average dyspeptic 
is, eat plenty of every real food that you feel an appe- 
tite for, and watch the results. 

If you are not relieved by this prescription, then you 
may feel reasonably certain, nine times out of ten, that 
the cause of your trouble lies outside of the realm of 
dietetics. If your dyspepsia tends to be of that unfor- 
tunate kind which has no appetite, then the thing for 
you to do is go and get one. And the place to get it 
is the place where appetites, like all other wholesome 
plants grow, out of doors. 

By far the commonest and most potent cause of 
dyspepsia is lack of exercise in the open air, and the 
second commonest is lack of rest. Very few people 
over-eat, but a great, great many people, particularly 
business men, indoor workers, and women of the well- 
to-do classes, under-exercise. It is not too much fuel 
in the fire box that makes clinkers, but poor coal and 
the lack of proper draft. From four to eight miles of 
walking a day or its equivalent in the open air will cure 
ninety per cent of all cases of dyspepsia in men, and 
from three to five miles or its equivalent, in women. 

Tonics, appetizers, and pepsins of all sorts are of the 
Evil One, for they, at best, simply trick you into swal- 
lowing, with an illusion of appetite and relish, food which 
your muscles are not prepared to burn up properly, for 
the real ultimate digestion of the food takes place in 
the muscles of the body. Muscle, not brain, is king of 
the body and sends its orders to the stomach in the 
form of appetite, to the lungs, for deeper breathing, 
to the heart for more rapid and more powerful beating. 



90 COMMON DISEASES 

and to the brain, to devise means for meeting those 
demands which result in what we are pleased to term 
thought. 

The only way in which we can affect, through our 
own voluntary acts, our stomachs, our livers, our 
hearts, and our nervous systems, is through our volun- 
tary muscles in the form of exercise. Pepsins and digest- 
ants of all sorts are peculiarly irrational and foolish, 
first because the stomach can make its own pepsin in 
abundance if it is properly fed and the whole body 
properly exercised ; in other words, hunger is the best 
digestant as well as the best sauce, and second, because 
careful analyses of our gastric juice in all forms of 
dyspepsia have shown that whatever may be lacking, 
pepsin is always present in abundance. Acid is the 
thing needed. Furthermore, two thirds of our so-called 
dyspepsia and chronic difficulties with digestion have 
their seat not in the stomach, but in the intestine in 
which pepsin is about as effective and useful as snow in 
Timbuctoo. 

The next great remedy for dyspepsia is rest, first 
after meals, second between meals, and third at night. 
The ten-minute lunch-counter lunch, and the twenty- 
two minute railway eating-station dinner, supposed to 
be typical of the American business man, are bad 
enough, but in view of the fact that they usually con- 
sist of a good variety of most nutritious, digestible, 
and well -selected food materials, a healthy stomach 
would be perfectly able to take care of them even if 
swallowed in chunks an inch square, if it were not for 
the equally hurried cyclonic rush back to the desk or 



DYSPEPSIA 91 

counter which follows them, thus giving the stomach 
no opportunity to call away from the brain and the 
muscles and the skin the supply of blood which it 
needs for starting its load on the way toward diges- 
tion and the manufacture of its gastric juice. 

And in one sense, exercise in the open air comes under 
the same head, in so much as it means giving the most 
overworked and incessantly occupied parts of the body, 
the brains and our nervous system, a comparative rest 
during the time devoted to it. But nine hours of good 
sound sleep at night, with the windows wide open, would 
be a wonderful help to most cases of dyspepsia, and the 
fifteen or thirty minutes' nap after lunch and a break 
about the middle of the afternoon for four o'clock tea 
would also be found exceedingly helpful for both men 
and women. And as for children, particularly of the 
restless, nervous, and irrepressibly mischievous type, 
who have no appetite and would rather play than eat, 
we simply put them to bed and keep them there until 
their appetite comes back and they begin to lay on fat. 

If neither abundance of good food nor exercise nor 
rest will relieve your dyspepsia, then the probability is 
that you have to deal with some special disturbance 
or defect either further down in the alimentary canal 
or entirely outside the digestive system. 

One of the commonest causes, for instance, of 
chronic dyspepsia is eye strain, and persistent lack of 
appetite or discomfort after eating or gas on the stom- 
ach or so-called gastralgia will be completely relieved 
by the fitting of a proper pair of glasses and the taking 
off of that incessant strain on the nervous system. 



92 COMMON DISEASES 

Another common cause of chronic digestive disturb- 
ances is catarrh, so called, by which is meant some 
persistent infective or suppurative process going on in 
the nose or throat. Closely allied to, and indeed more 
common and potent than this, is bad teeth, which act 
both by making proper chewing and mastication of 
the food impossible and also like catarrh by pouring 
down the throat into the unfortunate stomach one 
incessant stream of pus and the germs of suppuration 
or putrefaction. 

It is not too much to say that probably half of all 
cases of chronic dyspepsia are due to these three causes 
combined, — eye strain, bad teeth, and catarrhal 
conditions in the nose and throat. Go to a competent 
expert and have these conditions relieved and your 
dyspepsia will often disappear as if by magic. 

Of late years, we are discovering another set of condi- 
tions which are surprisingly common causes of chronic 
dyspepsia, particularly in the utterly unmanageable, 
serious, and painful varieties. These are inflammatory 
or diseased conditions of other parts of the alimentary 
canal. One of the commonest of these is our centuries- 
old friend which we have so recently discovered, ap- 
pendicitis. So frequently a factor is it that when we 
are confronted with a case of severe, persistent, and 
unmanageable dyspepsia, which has resisted treat- 
ment and for which we can discover none of the 
more obvious causes, we proceed to investigate most 
thoroughly the condition of the appendix. Even 
where there has been no marked open attack of append- 
icitis, a thickened, inflamed, adherent condition of 



DYSPEPSIA 93 

the appendix, with or without the presence of a stone 
or other fecal concretion, will be found, and when this 
has been relieved, the dyspepsia comes to an end. 
Next in frequency comes disturbance in another rudi- 
mentary "side show" of the food tube, the gall bladder. 
Many a chronic dyspeptic, especially if he has been 
subject to attacks of jaundice, will be promptly re- 
lieved by the opening and draining of an inflamed gall 
bladder or by the removal of a couple of dozen gall- 
stones. 

Still another cause of the more painful forms of dys- 
pepsia, especially those attended by much vomiting 
or the passage of blood, is an ulcer either in the stomach, 
or almost equally frequently in the duodenum or other 
part of the intestine. 

Last, but not least, those painful and quite common 
disturbances which affect the last and final segment of 
the alimentary canal, are also frequent causes of dis- 
tress referred to the stomach, as apparent disturbances 
of the digestion. The method of action of these disturb- 
ances lower down in the canal in producing dyspepsia 
may be roughly stated as of the "block" order. Each 
one of the segments of the alimentary canal below the 
stomach has the power, so to speak, to send up orders 
to the stomach to hold up the food when conditions 
are such that its coming would cause or increase pain. 
Fissures, ulcers or hemorrhoids, by block messages of 
this description, frequently cause prolonged delay of 
the food in the stomach, followed by putrefaction and 
formation of gas, heart-burn, and all the other familiar 
cycle of disturbances. 



CHAPTER V 

CONSIDER THE LIVER 

OF all the flowers born to blush unseen the liver 
is the most eminent. If it were only as conspicu- 
ous as the brain we should probably be just as proud 
of it. As it is it excels the brain in weight and is an 
even more desirable citizen and sturdier pillar of society. 
Yet we loftily ignore the liver's existence and never 
speak of it except when it is "out of order," though, 
as its mere size would suggest, it is one of the most 
important, most hardworked and overstrained as well 
as most delicately adjusted and exquisitely efficient 
structures in the body. It plays whatever tune it will 
upon the keyboard of the brain cortex, and colors the 
visions of the mind as a spotlight does the draperies of 
the ballet. 

Yet most of us do not even know where this power 
behind the throne sits in darkness. We refer pains in 
the left side of it to the heart, in the middle of it to 
the stomach, and call the remainder of its disturbances 
pains in the chest or stitches in the side. 

If we knew half as much chemistry as the liver has 
known these five million years past, the secrets of the 
universe would lie before us like an open book. Even 
to-day it is the most wonderful and resourceful chemi- 
cal laboratory in the world. Nothing can equal it — 
even in Germany. 



CONSIDER THE LIVER 95 

We think we have done wonders in discovering a 
poison that will kill or neutralize the toxins of a single 
germ — such as mercury, or the diphtheria antitoxin; 
but one little six-sided, sallow-looking lozenge of a 
liver cell — no larger than the head of a pin — not only 
can neutralize and destroy any one of forty different 
toxins and poisons that are brought to it by the blood 
but can split them up so ingeniously as actually to turn 
one part of them into sugar fuel, another into starch or 
fat, and another into harmless bile waste. 

It is the most wonderful poison sponge and toxin 
filter that has ever been invented or discovered. And 
the moment it is put out of commission the body goes 
down in a heap — choked by its own breath, as it were; 
poisoned by its own wastes tuffs. It is no wonder that 
the question "to be or not to be" — the problem of 
whether life be worth living — emphatically depends 
upon the metabolic integrity of our hepatic cytoplasm, 
to put it learnedly . When a man's " gall stops wukkin ,' ' 
as our African brethren picturesquely say , then nothing 
else much matters. 

The liver has one, at least, of the characteristics of 
great genius. It has always been misunderstood and 
estimated at far below its real worth and dignity. For 
centuries after it was introduced to our attention by 
the delicacy of its flavor when eaten raw or broiled on a 
forked stick over a campfire, it was regarded simply as 
the alter ego of bacon and one of the autocrats of the 
primitive breakfast table. It was even held in such 
lowly esteem as to enter into the vernacular synonym 
for abject poverty — "three in a bed and liver for 



96 COMMON DISEASES 

breakfast." In the quaint phrase of the old saw, "Ef a 
man wuz born in a stable thet does n't make him a 
horse." The liver was born of and from the food tube; 
but, like Wesley, it has taken all the world for its par- 
ish, and a powerful preacher of righteousness and clean 
living it has been. When a man says he has a clear 
conscience he usually means that his liver is working 
well. 

Until within recent years our knowledge of the liver 
was of the vaguest and most curious sort. Its first 
introduction to our official notice was at the hands of 
those quaint old mountebanks, the Roman augurs, or 
haruspices y who, in their temples and shrines, were 
accustomed to foretell the future and give advice in 
times of war and uncertainty by examining the inter- 
nal organs of freshly killed animals — much as their 
doddering lineal descendants to-day tell fortunes by 
reading the lines of the palm or interpreting the grounds 
in a coffee-cup. 

The liver was one of the augurs' highest trump cards 
in this kind of hocus-pocus, chiefly on account of its 
size and striking appearance, and also probably from 
the fact that it showed more changes which even their 
ignorant eyes could appreciate, as a result of the at- 
tack of different diseases or from the use of different 
kinds of foods, than almost any other readily discov- 
erable organ in the body. 

Nobody but an expert pathologist can make much 
out of the changes in the heart, even when it has 
been the site of fatal disease. The only readily obvious 
changes in the stomach are in its size, which even the 



CONSIDER THE LIVER 97 

limited intelligence of the augurs soon led them to dis- 
cover depended solely upon the amount of food it con- 
tained. And the lungs are merely more or less reddened 
and solidified "lights" to the general eye. The liver, 
however, which weighs three pounds and is the size 
of a Rugby football to begin with, may, if fatty or 
hypertrophic, swell up to six, seven, or eight pounds, 
and turn from dull purplish red to light golden brown 
in the process. In some diseases it may shrink down into 
a wrinkled and twisted three-quarter-pound slab of 
scar tissue no bigger than a slipper, when it is called 
atrophic — or, if knobby and sole-like, it is called "hob- 
nailed." 

Such changes as these are fit to conjure with; they 
give the imagination something to work on and furnish 
an excellent groundwork for prophecy — far more than 
most prophecies have in fact. 

When to these striking and dramatic changes, which 
the mass of the organ itself is capable of, are added 
additional variations and color contrasts furnished by 
the changes in size, color, shape, and thickness of the 
wall of the pear-shaped, dark green gall-bladder, con- 
trasting so vividly with the liver's dull purplish-red 
background, one can readily see what a superb asset 
in their primitive flimflam games the old augurs had 
in the liver. In their little game it was not hearts that 
were trumps but livers. 

Grotesque old harlequins and conjurers as they were, 
they were the harbingers and, indeed, the forefathers 
not only of religion but of medicine. Out of their vague 
and rambling conjectures grew up our whole theory of 



98 COMMON DISEASES 

psychology — the three faculties of the mind, for in- 
stance : the head, or intellect; the heart, or will; and the 
liver and bowels, or emotions. These, carried over into 
the realm of theology, produced such singular figures of 
speech as a "clean heart," "bowels of compassion," 
and so on. 

All our psychology — and our philosophy up to 
thirty -five years ago — was based frankly and flatly 
upon the philosophy of these primitive vivisectionists. 

On the borderland between mind and matter, between 
philosophy and physics, was built up the quaint old 
fairy tale of the four temperaments — the bilious, the 
sanguine, the lymphatic and the nervous. Each kind of 
temperament was supposed to be due to the dominance 
in the body of four corresponding fluids or "humors" 
— the bile, produced by the liver and stored in the 
gall-bladder, as any child could see for himself; the 
sanguine, produced in the heart and contained in and 
symbolized by the blood; the nervous, secreted by the 
brain and poured out all over the body through the 
nerve trunks ; and the lymphatic, secreted by the lymph 
glands or "kernels," such as can be felt in the neck and 
armpits and groins, and symbolized by that milky, 
whitish fluid, the lymph. Thus a man's "humor" 
literally came to mean his mental state. 

Even in scientific medicine we have scarcely yet 
shaken ourselves clear of the absurd obsession of the 
four temperaments, while in popular and psychological 
thinking it still holds full sway. In this quaint and pic- 
turesque game of colors and fluids and symbols the 
liver naturally took a high rank and played a pro- 



CONSIDER THE LIVER 99 

minent part on account of its many qualifications for 
striking the eye and its wide range of variations in size, 
color, and texture. 

Though we laugh at the augurs' methods of divining 
the future and of deciding what to do in case of doubt 
nowadays — except when we are very badly frightened 
or unusually silly, which happens even to the wisest 
of us once in a while — primitive practice has graven 
the liver deep into our language in such a way that it 
will never be effaced. We use the term "livery" or 
"bilious" quite as often to express that we are blue, 
and generally discouraged and out of sorts, as that we 
have a coated tongue or a burning stomach. 

Almost half of the words we use in describing men- 
tal states, particularly of a depressed character, are 
drawn from the liver. For instance, we have not the 
remotest idea that we are borrowing anything from 
those quaint old medicine-men or augurs — if, indeed, 
we ever remember having heard of them before — 
when we say that we feel "melancholy "; but when we 
come to dissect the word we find that it simply means 
in Greek "black bile" — in other words, that we are 
under the influence of an unusually large amount of 
biliary secretion in our system. 

To describe a more permanent mental depression 
we say that one of our friends has become a "hypo- 
chondriac"; and when that word is cut up it resolves 
itself into "under the cartilages," meaning the carti- 
lages or gristly parts of the lower ribs under which the 
liver lies. When we describe ourselves as "nervous" 
the nerve fluid is supposed to be secreted in excess in 



100 COMMON DISEASES 

our systems and to be overstimulating us and making 
us "jumpy" and excitable. 

So real a thing, for instance, was this nerve fluid 
believed to be that even as late as the middle of the 
fifteenth century great and distinguished surgeons, like 
Ambroise Pare, when amputating limbs, used to tie 
off not merely the arteries to prevent the escape of 
blood but the nerve trunks to prevent the escape of the 
nervous fluid, the loss of which, it was firmly believed, 
would cause the patient to bleed to death just as genu- 
inely as if an artery had been left untied. How exqui- 
sitely this tying of the nerve trunks must have added 
to the comfort of the unfortunate patient can be well 
imagined. 

Many of our proverbial differences of point of view 
are due to the particular poisons which, like the eagles 
at Prometheus', are gnawing at our liver. The old pro- 
verb, Tot homines, quot sententioe — "So many men, so 
many opinions" — would be nearer the truth if it 
read: "So many livers, so many grouches." What a 
man knows is a matter of his brain, but what he be- 
lieves depends on his liver. 

As medicine and religion have a common ancestry, 
which is one of the reasons why they sometimes 
"scrap" so cordially when they get together — it is a 
family fuss, — these necromantic ideas about the liver 
were transferred bodily into primitive medicine. From 
the very earliest times there has been a singular tend- 
ency to associate all depressed and melancholic or 
apathetic states of both mind and body with a dis- 
ordered condition of the liver. And the conjecture, 



CONSIDER THE LIVER 101 

irrational as was its origin and grotesque as is its logic, 
was not far wide of the mark after all. 

There is nearly always some rational basis, some ker- 
nel of truth, some shrewd guess underlying every pop- 
ular impression or even superstition, grotesque as it 
may be in its details and absurd in the extremes to 
which it may be carried. The germ of truth underlying 
all the old melancholic conceptions of the liver was 
that, as we have just discovered upon definite experi- 
mental grounds within the last half -century, our men- 
tal as well as our bodily states are very largely depend- 
ent upon the poisoning of our nerves and our brains 
by toxins carried to them in the blood from a hundred 
different sources within and without the body. And as 
we have also discovered in the past couple of decades 
that the liver is the great toxin absorber and antitoxin 
generator for the entire body, no matter what may be 
the sources of the poison, it is clear that our views of 
existence, and whether it is worth while continuing it 
or not, must depend very largely upon the efficiency of 
our liver-filters. 

Of course every one knows that the liver is a digest- 
ive organ, and that its main business is to secrete the 
bile. It does very much more than that, however, and 
the manufacture of bile is one of the least important of 
its functions. The stock of the bile has gone steadily 
below par ever since it was carefully investigated and 
accurately studied, and it is now regarded as chiefly 
an excretion or waste product, poured into the ali- 
mentary canal in order to be got rid of; though Nature, 
with her wonderful and irrepressible economy, has 



102 COMMON DISEASES 

contrived to utilize it on its way out for some trifling 
services and odd jobs, principally in the way of house- 
cleaning. 

Not only does all the blood from the walls of the 
active part of the food tube go directly to the liver 
through the great portal vein and its branches, thus 
carrying every particle of the dissolved food and any 
poisons that are contained in it direct!} 7 to the liver, but 
also the largest millrace current of blood from the great 
trunkline artery of the body — the aorta. — is received 
by the liver. This means, of course, not merely that 
almost every scrap of our food passes through the liver 
before any other tissue in the body can get even a smell 
of it but also that, owing to the size of the artery and 
the vigorous pumping of the heart, all our blood is 
driven through the liver-filter once in twenty minutes. 

The liver, then, is a combination of quarantine sta- 
tion and filter — first for the food, and second for all 
sorts of poisons in the blood from all over the body. 
No organ in the body has been more maligned and 
none is more worthy of our highest gratitude and es- 
teem. It has been accused from time immemorial of 
flooding the body with a dark green tide of its biliary 
secretion and producing not only that dark brown 
taste in the mouth but all the tortures of melancholia 
and biliousness, the " hip" and the " hump," out of 
sheer exuberance of spirit or pure cussedness. It really 
stands as a majestic sentinel at the main gate of the 
body-fortress, giving neither sleep to its eyes nor 
slumber to its eyelids day or night, testing with labor- 
atory rigidity every drop of melted food before allow- 



CONSIDER THE LIVER 103 

ing it to pass on to the muscle cells and the nerve cells, 
challenging every poison and toxin and arresting every 
invading bacillus or vagrant germ. 

Then when, worn out with overwork or over- 
whelmed by a sudden flood of poisons too powerful for 
it to check, it allows some toxin-invader to slip by it 
and play havoc with the cells of our nervous system 
we say we are "bilious" — and blame the liver! 

For many centuries, on account of its commanding 
position upon the great blood-stream that carries 
melted food from the alimentary canal to the heart, we 
supposed that the liver's chief if not only function was 
to deal with and bar out poisons contained in our food 
or resulting from its digestion and indigestion. Thus 
the principal causes of the liver's disturbances and 
diseases were supposed to be food and drink and the 
things that were mixed with them; but this has been 
found to be far too narrow a view. Indeed we are rap- 
idly coming to the opinion that a large share if not a 
majority of the diseases of the liver have little or no- 
thing to do, in their origin, with either food or drink. 

We have also come to realize that many of the so- 
called digestive disturbances of the liver are caused, 
not by the food itself, either in its amount, quality, or 
combinations, but by the bacteria or other germs or 
parasites with which food is contaminated and which 
are introduced with it, just as we have seen is the case 
also with dyspepsia, indigestion, and the disorders of 
the alimentary canal in general. 

The well-known "tropical" or "East Indian" liver, 
for instance, which is so common a cause of complaint 



104 COMMON DISEASES 

among retired merchants, traders, military officers and 
government officials who have served long terms in 
tropical climates, absurdly supposed to be due to the 
eating of too much meat, fats and other "heating" 
foods, is now known to be due almost solely to the at- 
tack of the disease germs and parasites that swarm in 
hot climates. Indeed probably two thirds if not three 
fourths of "tropical liver" is due to just two of these 
parasites — the plasmodium of malaria and the 
amoeba of dysentery. 

Scores of attempts have been made to produce en- 
largement, shrinking, fatty degeneration or other dis- 
eased conditions of the liver by feeding animals upon 
excessive amounts of different kinds of foods, espe- 
cially such as are supposed to throw most work upon the 
liver. It has been found utterly impossible to produce 
anything more than the most temporary disturbances 
by means of food, even when administered with a 
stomach-pump and utterly alien to the natural tastes 
and requirements of the animal; but the moment dis- 
ease germs were mixed with the food then it was per- 
fectly possible to produce, almost at will, any liver 
condition that might be desired. Certain animals 
which were unusually vigorous and healthy proved the 
exception, as they were able to destroy and digest even 
large quantities of these germs without any apparent 
effect upon their livers. 

Diseased conditions of the liver could also be pro- 
duced by mixing small amounts of mineral poisons like 
lead and arsenic with the food ; and one or two organic 
poisons like chloroform and alcohol were also found to 



CONSIDER THE LIVER 105 

have special injurious effects upon the liver. It was 
found necessary, however, much to the surprise of the 
experimenters when endeavoring to produce the classic 
so-called alcoholic changes in the liver, to administer 
it in very large amounts — sufficient, in fact, by its 
direct irritating effect upon the stomach, to set up 
a catarrhal irritation and inflammation of the lining 
of the alimentary canal. Thus the relation between 
alcohol and diseases of the liver, including the famous 
hobnailed or drunkard's liver, is not so direct as we at 
one time supposed it to be. 

In fact the action of the liver upon alcohol throws an 
interesting light upon its method of dealing with other 
poisons which, like alcohol, would be highly injurious 
to both nerve and muscle cells all over the body if they 
were permitted to get past the liver in their original 
form. The cells of the liver possess a remarkable and 
ingenious power of not merely stopping poisons as 
a filter might but of actually converting them into 
harmless substances which can be permitted to pass 
into the blood without injury to the body. 

This it does by breaking down or, in chemical 
language, "splitting" their molecules; and that is 
probably why the liver has so little power of antag- 
onizing or arresting simple metallic poisons like lead 
and arsenic — for their molecules are, in the first place, 
very small and simple; and, in the second place, when 
broken down or split up the fragments are still 
poisonous. 

What makes the problem still more difficult and the 
intelligence of the liver cell even more superhuman — 



106 COMMON DISEASES 

for the whole is not always greater than its parts 
except in pure mathematics, and little, insignificant, 
gumdrop-looking cells in our body can do things with 
one hand tied behind them, so to speak, which we 
could not do to save our lives — is that not only may 
all poisons except mineral ones be split into perfectly 
harmless compounds but also, conversely, all foods, 
however harmless and nutritious, may be split into 
poisonous compounds — and this splitting actually 
takes place in the process of digestion. 

For instance, two of the most dangerous of known 
poisons — the one on account of its deadliness and the 
other on account of its commonness — prussic acid 
and alcohol, are actually produced in the human body, 
not merely daily but hourly and every minute, in the 
process of digestion. The amount of prussic acid pro- 
duced, of course, is very small indeed; but the amount 
of alcohol is considerable, for the latest studies indi- 
cate that nearly a quart of it is formed in the body 
every twenty-four hours. The prussic acid is so 
promptly converted into something harmless, and the 
alcohol burnt so swiftly as fuel in the muscle-engine 
into simple carbonic acid and water, that these poisons 
have no time to do any harm to the body tissues; but if 
the liver were not strictly "on the job," like Doctor 
Wiley, day and night, think of what might happen to 
the body from the accidental poisons from its food- 
stuffs! 

If, therefore, you would avoid biliousness, first and 
foremost submit to the challenge of that matchless and 
incorruptible sentinel at the outer wicket of the gate of 



CONSIDER THE LIVER 107 

the body-fortress — the nose — every piece of food 
that you eat, and refuse to take into your mouth any- 
thing that smells tainted or "fishy," or musty or flat, 
or disagreeable in any way, or to swallow it if it tastes 
unpleasant. This will result in barring out, not only 
those spoiled foods which nobody likes, but also those 
half-spoiled foodstuffs and drinks which most of us 
have carefully trained ourselves to like in defiance of 
our instincts — such as alcohol, tobacco, sauerkraut, 
Limburger, and "hot stuff" generally. Though we 
should lose something in amusement, we should lose 
nothing in nutrition and gain much in health by so 
doing. 

Though bad foods and drinks will account for a 
considerable number of the milder and more short- 
lived attacks of biliousness and liver trouble they are 
very far from explaining the more permanent and 
lasting diseases of that organ. Indeed a conviction is 
steadily growing, as our study becomes more accurate 
and our experiences wider, that a large share if not the 
majority of chronic liver troubles are not due to food 
at all. 

The liver occupies one of the most dangerous posts 
in the entire body, as it is the testing point, filter and 
garbage burner to which are brought not merely all the 
poisons that enter with the food, or are formed in the 
alimentary canal as a result of indigestion, but at least 
two thirds of all the poisons, living and dead, that got 
into the body from other sources. It is only in recent 
years that we began to discover the enormous and im- 
portant part the liver plays in our bodily resistance to 



108 COMMON DISEASES 

the attacks of fevers, that is to say, of the germs of 
infectious diseases. 

We have long known, of course, that in certain in- 
fectious diseases, especially those that were chronic or 
lasted for long periods of time, such as malaria, the 
liver became very much enlarged and would after- 
ward be found to be in a highly diseased condition, 
even though the patient had survived the immediate 
attack of the infection for many years. 

The same was true, of course, in the chronic dysen- 
tery of the tropics, in gout and in certain forms of pro- 
longed poisoning by inorganic poisons like lead and 
phosphorus; but these facts did not make much im- 
pression on our minds, as we merely put them down to 
the fact that the liver suffered from prolonged satura- 
tion of the disease poisons just as any other organ or 
tissue in the body would. 

A decade or so ago, however, our attention was 
called to the promptness with which the liver would 
be attacked by certain poisons in a rather dramatic 
and unexpected manner. This came only when we 
were investigating and endeavoring to find the cause 
of a number of sudden deaths after the taking of 
chloroform for prolonged surgical operations. Much 
to our surprise the most striking and uniform feature 
in most of these cases after death was fatty degenera- 
tion of the liver. We had previously supposed that 
changes of that sort took weeks if not months to pro- 
duce, but this discovery set the pathologists to think- 
ing and experimenting; and it was quickly found, first, 
that this sudden fatty degeneration could be readily 



CONSIDER THE LIVER 109 

produced in animals by large single doses of chloro- 
form and other poisons, and also, what was still more 
interesting, by infecting the animals with the germs of 
various contagious diseases. 

That sent us back to the post-mortem room at once, 
to examine the livers of those who had died of such 
acute infections; and we were not long in discovering 
that the most profound and serious changes produced 
anywhere in the body of our patients, by even such 
diseases as pneumonia, typhoid fever, scarlet fever, 
childbed fever, surgical fever or blood poisoning, and 
diphtheria were often to be found in the liver. The 
reason why these changes had escaped us before was 
that they seldom made much change in either the 
size, or color, or appearance of the liver to the naked 
eye, and that it was necessary to make a microscopic 
examination of the liver-stuff in order to be sure of them. 

This gave us a clew to a number of these cases — for 
instance, why jaundice should occur in fatal cases of 
a good many acute infections, such as typhoid fever, 
malaria, childbed fever, pneumonia, and peritonitis or 
blood poisoning. It explained why, in certain exceed- 
ingly fatal forms of pneumonia, such as the dreaded 
"miners' pneumonia" of our Western mining camps, 
the liver should be found after death as a blackened 
and broken-down mass, so destroyed and altered that 
it had attracted the attention of even the mining- 
camp doctors, and the disease had become popularly 
known as "Black Death of the liver. " 

In fact by piecing together all our information we 
came to the conclusion that the first place, so to speak, 



110 COMMON DISEASES 

to which the germs and poisons of infectious diseases 

— no matter where they might have entered the body 

— were hurried by the blood stream was the liver; 
that it bore the first brunt and the heaviest shock of 
their attack; that so long as it was able to neutralize 
the poisons and arrest or destroy the germs the in- 
fection did not "take" and the body, as a whole, 
escaped the attack of the disease — in short, that 
resistance to a given disease, and the question as to 
whether we succumbed to an infection and developed 
a full-grown attack or not, depended largely and 
fundamentally upon the liver. 

Further, in cases where its first resistance had been 
overcome and the body had proceeded to develop a 
general attack of the disease, the extent to which the 
liver was able to neutralize the toxins produced by 
the germs all over the body would be the measure 
of the vigor with which we would resist the attack; 
and the question of recovery was largely a matter of 
whether the liver was able to rally its forces and grad- 
ually get the upper hand of the invaders, or whether it 
sank under their attack and finally relinquished the 
field to the enemy. Whatever our final disease, a large 
majority of us die by liver failure, followed quickly 
by heart poisoning. When the heart fails in the final 
exitus it is because its muscle cells have been fed with 
unneutralized poisons instead of food by the blood. 

Most forms of overgrowth or enlargement of the 
liver are now believed to be due to a rapid multiplica- 
tion of the liver cells under the attack of the poisons of 
some infectious disease. 



CONSIDER THE LIVER 111 

Even in its fall the liver remains loyal to the body, 
for this enlargement or overgrowth, which was origin- 
ally regarded as purely inflammatory, has now been 
discovered to be an actual increase of new and com- 
paratively healthy liver tissue. In other words it is a 
genuine attempt at growth on the part of the liver in 
order to cope with the increased amount of poisons 
brought to it. 

Probably a large share of these enlargements achieve 
their aim, conquer the poison, and again disappear 
without ever having attracted our attention at all; 
but a considerable number of them are not so fortu- 
nate, and the newly formed cells begin to break down 
and their places are taken by fibrous or scar tissue. 
This as it matures hardens and shrinks, crushing within 
its pythonlike grasp the remaining healthy liver cells; 
and in the course of months or years our overgrown 
liver is converted into a leathery, shrunken, scar- 
indented mass of fibrous tissue, with only a few 
islands of healthy liver cells scattered about. 

Whenever these few islands get below the minimum 
neutralizing requirements of the body the patient dies; 
but if he lives long enough the process will go on until 
the shrinking has reduced the liver to a half or even a 
third of its normal size. So that whether a man dies 
of an enlarged or a shrunken liver depends chiefly 
upon the stage of the process at which his vitality 
gives way. 

Even in the present stage of our knowledge it is 
probably not too much to say that if you have been 
fortunate enough to avoid certain of the great dis- 



112 COMMON DISEASES 

eases that have a special tendency to attack the liver, 
such as typhoid fever, malaria, dysentery, and pneu- 
monia; or if you have made a good recovery and 
given yourself every reasonable chance by skillful treat- 
ment and rest to throw off their effects, you need have 
comparatively little fear of serious disease of your 
liver. As there is no earthly reason why these four 
great diseases, together with many others that play a 
lesser part in damaging the liver, should not be 
wiped out entirely — and their conquest is now 
only a question of time, intelligence, and money — it 
can be seen that the prospect for the liver is anything 
but discouraging. 

As has already been intimated some permanent or 
chronic diseases of the liver are produced by the pro- 
longed absorption of small amounts of inorganic poi- 
sons, such as lead, phosphorus, and arsenic, usually 
introduced into the bodies of workers in particular 
trades involving the handling of these poisons. For- 
tunately the public conscience has now become 
awakened on this subject and is insisting in no uncer- 
tain tones that no individual, however successful or 
able, shall be allowed to poison his fellow beings for 
his own profit; and that any industry which cannot be 
conducted without ruining the health and threaten- 
ing the lives of its employees shall be. put out of busi- 
ness. 

Our motto in considering diseases of the liver to- 
day emphatically is "Look for the poison." We are 
not only finding the poisons with accuracy and dis- 
patch but discovering that nine tenths of them are 



CONSIDER THE LIVER 113 

preventable and may be avoided by the exercise of 
ordinary cleanliness and intelligence. 

Considering the ancient source of our beliefs about 
the liver, it is small wonder that many of them have 
little more foundation than the alleged influence of 
the stages of the moon on the growth of potatoes. 

A good illustration is afforded by those familiar 
blotches of brownish or yellowish color upon the face 
and neck, which are known the world over as "liver 
spots," Leber Flecken, and so on. These have nothing 
whatever to do with the liver, but are a curious alter- 
ation in the amount of coloring matter or pigment 
which is present in every skin, even the whitest. 
They are probably due to some disturbance of the 
nerve twig supplying the patch of skin affected, and 
usually appear in conditions in which there is ex- 
tensive disturbance of the nervous system, such as 
certain chronic nervous diseases and the curious 
wasting and disorganization of the skin which occurs 
in old age. Their appearance need not give rise to 
any uneasiness, as they seldom become marked enough 
even to disfigure the complexion, they never give rise 
to any other than cosmetic trouble, and disappear 
when their cause is removed. 

The only reason, in fact, why these spots were ever 
connected with the liver, even by name, was that, to 
the innocent and childlike eyes of our ancestors of the 
Middle Ages, these marks bore a slight resemblance in 
hue to the color of that one fairly common disturbance 
of the color of the skin which is caused by the liver, the 
well-known jaundice, or "the yellows." Even the 



114 COMMON DISEASES 

frequency of this disturbance has been enormously 
exaggerated, and our ideas of its causation began, like 
most of our hepatic beliefs, simply by our putting the 
cart before the horse. 

Jaundice is not due, as popularly believed, to the 
liver working overtime and pouring more bile into 
the blood than the body can dispose of, but to either 
that form of body waste which colors and forms the 
bile being produced in greater quantities than the 
liver can handle, or the tube called the bile duct, 
through which the liver pours bile into the intes- 
tine, becoming blocked by gallstones or inflammatory 
swelling. 

Among the garbage-burning and waste-purifying 
functions of the liver is the duty of taking care of and 
discharging from the body the remains of the red blood 
corpuscles which are broken down in the work of the 
body by millions and billions every day. It is the well- 
known red coloring matter — ■ hemoglobin — of these 
corpuscles, which when broken down causes the yel- 
lowish or greenish color of the bile. Exactly the same 
change can be easily seen taking place in the classic 
* 'black eye," or the black and blue — more accurately 
black and green — discoloration of a severe bruise any- 
where upon the body. 

A blow that makes a black mark is simply one which 
has ruptured one or more tiny blood vessels and allowed 
the blood to escape into the tissues, where it quickly 
undergoes this greenish discoloration. What happens, 
then, in jaundice is that, to put it roughly, some poison 
or poisons in the system are breaking down the red 



CONSIDER THE LIVER 115 

blood cells with greater rapidity than usual; so that 
the liver is unable to filter their coloring matter out of 
the blood rapidly enough and the whole body becomes 
dyed a yellowish green. 

That is why diseases which directly attack the red 
cells of the blood, such as malaria, are so often accom- 
panied by either jaundice or a yellowish discoloration 
of the skin. A striking illustration is shown in the 
dreaded yellow fever, in which, so to speak, all the 
blood in the body starts to melt and break down at 
once, leaking out on the surface of the skin to form the 
dreadful yellow mask, and through the thinner and 
more porous wall of the stomach to produce the fatal 
"black vomit." Any of the acute infections — even a 
common cold — may be followed by mild jaundice. 

The other chief way in which jaundice is produced is 
by a blocking up of the bile ducts, so that the liver can 
no longer pour the bile which it has separated from the 
blood into the bowels to be got rid of. The commonest 
cause of this obstructive jaundice is, of course, the 
formation of gallstones or inflammatory processes in 
the gall-bladder; and it can be cured by opening the 
gall-bladder and either draining out the germs which 
are causing the inflammation or removing the gall- 
stones which are obstructing the bile ducts. 

As a matter of fact, however, jaundice is not one 
fourth so common as is popularly supposed, for the rea- 
son that, having once identified the liver and the bile 
with melancholic frames of mind and depressed con- 
ditions of the system, it was instantly concluded that 
any one whose complexion appeared sallow or yellow, 



116 COMMON DISEASES 

or of a greenish hue, was suffering from jaundice or 
an attack of " liver." What really happens is this, that 
all human skins, even the whitest, have considerable 
yellowish pigment in them — people of average com- 
plexion a good deal, and those of brunette complexion 
still more. In conditions of vigorous health this yellow 
tint is masked or neutralized by the abundant supply 
of red blood in the vessels of the skin; but when either 
the amount of blood in the skin is diminished by a 
weakening of the force of the heart beat or the color 
of the blood itself becomes less vivid from disease, 
then this natural yellow tint stands out in all its na- 
ked hideousness. That is why the majority of people, 
when they become pale or anaemic, become yellow 
or sallow at the same time. 

This natural pigment or coloring matter in the skin 
has also given rise to an absurd old popular supersti- 
tion that persons of brunette or dark complexion are 
more subject to liver trouble and more readily be- 
come bilious, the only basis for this belief being that 
when from any cause the rosy hue of health disappears 
from their skins their natural yellow or brownish 
color stands forth with vivid distinctness. They are 
not a particle more bilious than the palest and chalk- 
iest-faced blonde. Those of us with more than a cer- 
tain amount of pigment in our skins, popularly known 
as brunettes, turn yellow instead of white when we 
become pale. 

Not infrequently the liver falls a victim to its own 
devotion from the fact that some of the numerous 
germs or parasites which are carried to it to be strained 



CONSIDER THE LIVER 117 

out of the blood manage to find a foothold and grow in 
its own tissues — not very frequently, fortunately, for 
the liver is a tough and wary old fighter; but often 
enough to cause the death of the body later. 

One of the commonest invaders to find a foothold in 
the liver in this way is the tubercle bacillus. Tubercu- 
losis of the liver is a fairly common complication — 
next, indeed, after that of the lungs and the bowels. 
The human liver, however, resists tuberculosis very 
well, and its attack is seldom the cause of death; but 
in cattle and birds, particularly domestic poultry, the 
liver is one of the commonest sites of tuberculosis; and 
the most serious changes that take place anywhere in 
the body occur here. In birds, for instance, it is three 
or four times as frequently affected as the lungs are, 
just reversing the usual human proportion. It is well 
for wary housekeepers to do a little "liver-gazing" on 
their own account, and to insist on seeing and carefully 
examining the liver of every chicken and turkey they 
buy. 

The commonest organic disease of the liver is ab- 
scess, which again is due to the setting up of inflam- 
mation or pus formation in the liver by various disease 
germs — most commonly those which cause dysentery 
or diarrhoeal disturbances of the bowels, and are from 
that point carried to the liver. The well-known 
"tropical abscess" of the liver is largely due to the at- 
tack of the germs of dysentery, diarrhoea, or malaria. 
Several of the animal parasites that infest the ali- 
mentary canal are also carried to the liver, and one 
group of them, the so-called hydatids, undergoes a 



118 COMMON DISEASES 

stage of development there, producing large cysts or 
bladderlike growths filled with fluid and with the 
larvae of the parasite. One of this group of parasites is 
exceedingly serious and fatal in both cattle and sheep 

— the famous, or rather infamous, liver fluke. 

The liver also, like every other organ consisting of 
epithelium or secreting stuff, is subject to the attack 
of cancer, and in rather a high degree, being about the 
fourth most common site of cancer in men, only the 
lips, tongue, stomach and bowels ranking ahead of it — 
and the sixth most frequent in women. Even this, how- 
ever, serious as it is, is far from the hopeless death sen- 
tence that it was fifteen or twenty years ago. Modern 
surgery, with its perfected methods, does not hesitate 
boldly to attack and remove cancer or any other 
growth from the very substance of the liver itself, and 

— if its presence can be detected early enough — with 
fair success. 



CHAPTER VI 

CATARRH, OUR NATIONAL NASAL LUXURY 

HOW far do our defects make up our personality? 
Certainly it is our departure from the normal, 
from the dead level of the mass, that distinguishes, that 
makes our individuality. And these departures are al- 
most as often downward as upward, defects as virtues. 
Rid us of all our faults and our peculiarities of temper, 
and our friends would have great difficulty in recog- 
nizing us in Heaven. Even national traits, characteris- 
tics that are supposed to distinguish peoples and to 
mark them off from the rest of the race, may be de- 
fects, or based upon defects. 

The two characteristics that are unanimously agreed 
upon by visitors to our shores as distinguishing the 
typical American are his high-pitched, nasal speech 
and his lank and angular habit of body. The first of 
these is frankly ascribed to the universal prevalence of 
catarrh, and the second to the American habit of bolt- 
ing food and of promiscuous expectoration. 

In fact, I believe that, to the average European 
mind of even the intelligent class, an American with- 
out a catarrh or a dyspepsia would be as unthinkable 
as an Irishman without a brogue. That this popular 
impression is considerably less than a half-truth is 
certain, but what precise percentage of truth may 



120 COMMON DISEASES 

underlie it is impossible of accurate determination, for 
the reason that no data or statistics as to the actual 
prevalence of either catarrh or dyspepsia exist on either 
side of the Atlantic, neither of these diseases being 
fatal. Catarrh of all sorts is exceedingly common in 
both hemispheres, and any one who has had experience 
in nose and throat clinics in Xew York, in London, in 
Berlin or Vienna, would find it very difficult to state 
on which side of the Atlantic it is more prevalent. 

One thing that much confuses the matter is that in 
Europe in general, and in England in particular, dis- 
turbances of nose and throat are very seldom referred 
to as "catarrh." I have heard intelligent Englishmen, 
who were perpetually snuffling and hawking, indig- 
nantly repudiate the suggestion that they had catarrh 
— "that disgusting American disease!" They had 
only a little stuffiness in the head, a chronic bad cold, 
and "everybody runs at the nose a little in the winter 
months ! " As the American stands aghast at the laconic 
frankness with which the average Englishman or Eng- 
lishwoman will, in ordinary conversation, refer to the 
different sections of his or her anatomy, so the English- 
man is shocked by the frankness, and even cheerful- 
ness, with which an American will admit that he has 
catarrh or dyspepsia and proceed to discuss delightedly 
his symptoms in public. At least two thirds of the 
supposed difference in the prevalence of catarrh in 
England and America is due to the fact that the Ameri- 
can talks about it and the Englishman does n't. 

Therefore, we may rid our minds of the uncomfort- 
able beliefs that catarrh is a peculiarly American dis- 



CATARRH 121 

ease, a new disease, or an increasing disease. These 
impressions may be correct, but we have absolutely 
no trustworthy data upon which to base them, and all 
the presumptions and probabilities of the cause run 
strongly in the opposite direction. 

Inasmuch as catarrh is chiefly due to repeated infec- 
tions, to foul, overheated air, to lack of cleanliness and 
proper care of the nose and throat in childhood and to 
unsanitary conditions generally, the probability is that 
it is steadily diminishing in frequency and in severity, 
as all these conditions are being improved or wiped out. 
Certain it is that the more repulsive and distressing 
forms and results of the disease are rapidly becoming 
rarer as a result of increasing intelligence and the 
quickening of the hygienic conscience. 

Whether the high pitch and nasal twang of Ameri- 
can speech are due to catarrh is an open question. Cer- 
tainly other nations and localities have catarrh with- 
out having their voices made nasal thereby ; indeed the 
affliction seems rather to make the voice more guttural 
and husky. 

What is catarrh and why does it attack the nose? 
Few things are more difficult to make than precise 
definitions. They are impossible, in fact, in any but 
the exact sciences, and medicine is not yet one of these 
— it has too much human nature in it. Catarrh is 
an exceedingly vague and general term; oddly enough, 
even more so in medicine than in popular usage. In 
medicine catarrh is the name of a symptom, without 
any reference whatever to its cause. Roughly speak- 
ing, any disturbed condition of a surface attended by 



122 COMMON DISEASES 

an unusual amount of discharge, or flowing, is called 
catarrh. Thus, the catarrh of popular speech is known 
as nasal catarrh; attacks of stomach disturbance at- 
tended by the pouring out of mucus are known as 
gastric catarrh or catarrhal gastritis; and we may have 
catarrhal disturbances of the liver, the intestines, the 
appendix, and practically any region of the body that 
is lined by mucous membrane. In the olden days we 
used often to speak of inflammations of the skin at- 
tended by much weeping or flowing, such as eczema, as 
catarrh of the skin. This is in accordance with the 
meaning of the word catarrh, which is derived from 
two familiar Greek words, kata, down, and rheo, to run 
or flow — literally, a "pouring down" or discharge. 

Even nasal catarrh is very far from being a single, 
individual, definite disease. Strictly speaking, there is 
no such disease, as the name is based solely upon re- 
sults and means only a chronic irritation of the nose and 
throat, usually accompanied by more or less discharge, 
thickening and obstruction, which may be due to forty 
different causes. It is, in fact, as vague a term as head- 
ache, or lameness, or general debility. We are not even 
sure whether it is due chiefly to external or internal 
causes — to dust, gases, microbes, or other irritating 
features breathed in through the nostrils, or to pecu- 
liarities and lack of vigor and resisting power in either 
the nose in particular or the system in general. Prob- 
ably in most cases we have a combination of both 
these factors. Few permanent cures of catarrh are ever 
effected by treating the nose alone. 

To put it briefly, there are three main factors in the 



CATARRH 123 

production of that delightful complex of choke and 
snuffle and hawk that we call catarrh. These are, first, 
the irritating features of the air inhaled, such as cold, 
dryness, dust, gases, and germs; second, the shape and 
size of the nose and nasal passages; and third, the gen- 
eral vigor or weakness of the entire system, and the 
corresponding poorness or richness of the blood. At 
least two of these conditions must be present for ca- 
tarrh to develop. The most infectious of germs, the 
most irritating gases, the rawest of air will fail to de- 
velop more- than a mere temporary inflammation or 
irritation, which is quickly thrown off by vigorous, 
healthy individuals, who take plenty of exercise in the 
open air, plenty of cool baths, and who sleep with their 
windows open. On the other hand, it is extremely 
doubtful whether even the feeblest and flabbiest of 
individuals, not actually diseased, would ever develop 
a catarrhal condition of the nose or throat so long as 
germs and dust were entirely excluded from the air 
that they breathe. And the worst and most obstinate 
cases of catarrh are usually found in individuals who 
have the third factor present — some blocking or de- 
formity of the nasal passages. 

Contrary to popular impression, neither climate nor 
occupation plays any important part in the production 
of the disease. It is of nearly equal frequency and 
severity all over this American continent, from the 
Arctic cold of the Hudson Bay to the tropical heat of 
Florida and Louisiana, and from the raw moisture of 
the New England coast and the New Jersey marshes to 
the Sahara-like dryness of Arizona. That the dry, 



124 COMMON DISEASES 

sunlit regions of the great Southwest are exempt from 
catarrh is little more than popular illusion based upon 
ignorance. Many patients going there from raw, cold, 
changeable Northern and Eastern states improve for a 
time, but are apt to relapse or to develop the trouble in 
some other form; while not a few individuals who go 
there without catarrh at all develop it from the dust 
and the stinging, cracking dryness of the desert air. 

Man was born under water, grew up in the marshes, 
and became an amphibian and later a land animal at 
a comparatively recent stage of his career. 'Moisture is 
as indispensable to his existence and welfare as sun- 
light, and a too dry air and climate are even more 
unwholesome than a too damp climate. Indeed, as we 
shall see, the most elaborate and unstable part of his 
nasal mechanism is that which is devised for the pur- 
pose of moistening the air that he breathes, and dry, 
hot, foul air is responsible for far more catarrh than 
moist, cold air, however raw. 

Almost the only influence exerted by climate and 
occupation in the production of catarrh is the indirect 
one of the amount of confinement in unventilated, ill- 
lighted rooms, rilled with air that is foul whether from 
emanations from human skins, breaths, and teeth, or 
from the irritating chemicals, gases, and dusts of some 
industry or occupation. 

There are regular and recognized forms, for instance, 
of occupation catarrhs — diseased conditions of the 
lining membrane of the nose due to incessant and per- 
petual irritation by dust or gases floating in the air. 
Thus we have fur-workers' catarrh, from the perpetual 



CATARRH 125 

tickling and irritation caused by tiny particles of 
broken hair and fluff breathed into the nose; carpet- 
makers' catarrh, from constantly breathing air thick 
with lint and, where shoddy is used, loaded with dis- 
ease germs and all kinds of filth as well; printers' 
catarrh, from inhaling the clouds of carbon dust due to 
the dried printers' ink that is rubbed and shaken off 
the type as it is handled; match-makers' catarrh, from 
the fumes of sulphur and phosphorus; and a dozen 
others. Most of these occupations have, also, a very 
high death rate from consumption — due, of course, to 
the germs that float about and are inhaled with the 
dust in the crowded, ill- ventilated rooms in which the 
work is done. These appear either to be inhaled di- 
rectly into the lungs through the mouth, on account of 
the obstructed condition of the nose, or else to be en- 
abled to penetrate into the blood by means of cracks 
and ulcers and other weak spots in the chronically 
inflamed and irritated mucous membrane of the nose. 
This brings us to the most important single fact in 
the whole problem of catarrh — namely, that the 
much-abused and much-enduring nose is not running 
and stuffing up out of pure incompetence or natural 
cussedness, but as a vicarious atonement for the rest of 
the body. What it suffers it suffers in a noble attempt 
to protect the rest of the body. The nose is both sen- 
tinel and scapegoat in one — one of the real unsung 
heroes of the body state — and all that it gets in the 
way of reward for the matchless devotion and splendid 
courage of its unfaltering attack upon every enemy 
that comes on the wings of the air is catarrh and con- 



126 COMMON DISEASES 

tumely. We are quite prepared to accept the warning 
of Proverbs to "Keep thy heart with all diligence; for 
out of it are the issues of life"; but we are forgetful 
of the twin hygienic commandment that should run: 
"Keep thy nose with diligence, for into it are the 
issues of death." Most of us forget that we have such a 
thing as a nose except when it blocks up or begins to 
run or makes us disagreeably aware of cooking or of the 
passage of the modern Juggernaut, the automobile. 

Whether we ever were water animals, marine organ- 
isms, or not, the solid, unquestionable and immensely 
practical fact remains that all our body cells still are 
such, and can live and work and reproduce only when 
kept swimming in and saturated with water — and 
salt water at that ! Every life process must take place 
in the wet, under water; and dryness is death, or sus- 
pended animation. We are literally walking aquari- 
ums, except for a fraction of a per cent of the cells upon 
the surface of our skin and in our hair and nails, and 
most of them are from one half to three fourths dead 
before they even begin to be dry. 

Evidently, then, the only way in which air can be 
safely drawn into the moist, warm, living interior of 
the body is by arranging for its warming, moistening, 
and purifying as near the point of entry as possible. 
This is precisely what the nose undertakes to do, 
and is the fundamental why and wherefore of catarrh. 
How wonderfully successful it is in its attempt may be 
seen from the fact that air drawn into the nostrils at, 
say, forty degrees is in the incredibly short distance of 
about three inches raised nearly fifty degrees, satur- 



CATARRH 127 

ated with moisture and purified of nine tenths of its 
dust and germs. A curved thermometer passed in 
through the mouth so as to reach up into the back of 
the throat behind the soft palate shows that every 
breath of air drawn at an outside temperature of fifty 
degrees has been raised to eighty-five degrees by the 
time it reaches the pharynx. Also, it has been moist- 
ened and purified in proportion. 

Do you wonder that the warming, moistening, and 
purifying apparatus of our poor noses sometimes 
breaks down under the strain of this miracle? How 
does the nose accomplish this warming and purifying 
process? On the familiar principle of the warm coil 
or the steam radiator. Instead of remaining a straight, 
smooth-walled, double passage it thrusts out from 
each of its walls three great elastic cushions, one above 
the other, called the turbinated — "scroll-like" — 
bodies, composed chiefly of coils of blood-vessels sup- 
ported by a thin skeleton of bone and covered with 
soft mucous membrane. 

On account of the elasticity of the meshes of blood- 
vessels in them, these bodies are capable of being 
puffed out like great air cushions, so as, in an emerg- 
ency, almost completely to close the nostrils, thus 
rendering it difficult to draw air through them. We 
all experience this protective, balloon-like action in 
the promptness with which our nose blocks up when 
we step from a warm room into a temperature of 
ten degrees below zero on a winter morning. 

The method of the nose for straining dust out of the 
air is simple in principle, though elaborate in applica- 



128 COMMON DISEASES 

tion. It is the familiar fly-paper, or sticky surface, 
covered in this case with a mucus tenacious enough 
promptly to tangle and stop all articles floating in 
the air, whether dust, lint, or germs. Chronic nasal 
catarrh, or catarrh proper, is, in the majority of in- 
stances, due to the "hang-over" or after-result of acute 
catarrhs or colds. In fact, a chronic catarrh might be 
defined as a permanent or at least very lasting, half- 
cured acute catarrh or cold. The big cushion valves — 
turbinated bodies — remain about half distended. 
The soft, delicate mucous membrane is swollen and 
sodden and spongy. The cushion- valves can neither 
expand to shut out sudden rushes of cold or dirty air 
nor contract so as to allow the free inflow of pure, 
clean air.- Such dust and germs as are caught upon the 
mucous fly-traps, instead of being washed down and 
swallowed, stick and accumulate until they produce a 
raw spot on the surface of the membrane that cracks 
and deepens to an ulcer. These ulcers, by perpetual 
succession of irritations, get deeper and deeper until 
they eat even into the cartilages of the nose itself. 

The secondary effects are almost as injurious. The 
victim, unable to breathe comfortably through his 
nose, draws in air through his mouth. This rushes 
directly back almost unwarmed, unmoistened, or un- 
purified, or very imperfectly so, to the back of the 
throat or pharynx, and into the voice organ or larynx. 
Here, combined with the sticky, half-putrid, pus- 
containing discharge from the back of the nostrils, it 
sets up an irritation in the pharynx, and a chronic sore 
throat results, which process is very likely later to 



CATARRH 129 

extend to the larynx, producing hoarseness and dis- 
comfort in using the voice. It cannot be too clearly 
borne in mind that two thirds of the diseases of the 
voice and vocal organs are due and secondary to 
diseases of the nose! 

Meanwhile, the irritation and inflammation in the 
pharynx has been spreading in another direction, up- 
ward and outward. It soon reaches the mouths of the 
Eustachian tubes, those little remnants of the first gill- 
slits which run from the back of the throat or pharynx 
up to the drum cavity of the ear. The inflammation 
closes the mouth of the tube so that bubbles of air can 
no longer be sent from the throat to keep the drum 
properly inflated. The air of the drum cavity is 
absorbed into the blood, making a partial vacuum 
behind the drum. The pressure of the atmospheric air 
on the outer side of the drum promptly pushes it in, 
and we have the first stage of that sinking in and 
thickening of the drum membrane which is the cause 
of two thirds of our deafness. 

Later the inflammation spreads right up the Eus- 
tachian tube from the throat into the ear, and we get 
an attack of earache with, perhaps, rupture of the 
drum or, more probably, permanent thickening and 
dulling of the hearing. Three fourths to nine tenths of 
all diseases of the ear and disturbances of hearing 
reach it from the nose and throat. The only safe and 
sure time to cure either ear trouble or laryngeal trouble, 
in nine cases out of ten, is while it is in the nose! If 
these diseases are treated in their nasal stage nine 
tenths of them can be cured. If they are left until they 



130 COMMON DISEASES 

have reached the ear seven tenths of them cannot be 
cured. 

Now, what is to be done to prevent the lion's share 
of catarrh and catarrhal trouble due to germs? War- 
fare against such myriads of tiny enemies, that dance 
about us everywhere like motes in a sunbeam, looks 
almost hopeless. Fortunately, however, it is far from 
being so. While we do not know the names of most 
of these catarrh criminals and have not even their 
pictures in our pathological rogues' gallery, yet we do 
know something of their habitat and the company 
they keep, which is exceedingly useful for practical 
purposes. Unfortunately, their favorite company — 
with apologies to Lindley Murray — is us, but, 
luckily, us only under certain conditions and sur- 
roundings. Not one of them, for instance, is found 
anywhere in the fresh, open air of the country or in 
the air of reasonably clean and decent areas of the city. 
All of them, without exception, are to be found in 
the stuffy, mousy, unventilated air of rooms, halls, 
churches, and theatres which has not been changed for 
half a century. Keep out in the open air as much as 
you can; work, whether standing or sitting, in a gentle 
current of air, and sleep with the windows open — if 
possible, in a breeze — and you will avoid two thirds 
of your risks of colds and catarrh. 

The testimony as to the impossibility of catching 
cold in the open becomes more overwhelming and 
unanimous every day. It is only necessary to note the 
last addition to it — that of both the claimants to 
Polar honors. Neither Peary nor Cook, nor any one 



CATARRH 131 

of their parties — starting, of course, as picked, vigor- 
ous men free from disease, dirt, and germs — had a 
trace of a cold, bronchitis, pneumonia, or catarrh 
during the whole of the sojourn in the Arctic regions, 
though often under the most trying conditions as to 
cold, wet, and exposure. The moment, however, that 
they reached civilization on their return — Cook in 
Greenland and Peary at Sydney — from one third to 
one half of their parties took furious colds and sneezed 
and snuffled and wept to celebrate their return to 
warm houses and foul air. 

Against this cause of catarrh there is only one pro- 
tection, and that is the gods of the fields and the 
woods, the west wind and the sunshine. Spend as 
much of your time as possible out-of-doors — and that 
ought always to be two thirds of it in childhood — 
and resolutely bring the outdoors indoors at every 
hour of your working and sleeping day. At the same 
time insist upon the most rigorous and scrupulous 
cleanliness of clothing, hands, and person; of floors, 
carpets, walls, and hangings — anywhere, in fact, 
where dust or dirt can lodge, and germs can and 
do lodge. The more spotlessly clean and flooded with 
sunlight any house and its occupants can be kept the 
more nearly germ-free they will be. One reason why 
there are so few germs of harmful character out-of- 
doors is that they cannot live and thrive in sunshine 
and fresh air. It is only the houses that we build that 
are their hatcheries — literally, greenhouses for germs. 

But germs are not the only things that are required 
to produce catarrh. On the one hand, some people 



132 COMMON DISEASES 

would have trouble with their noses if there never was 
such a thing as a germ in the air; and on the other, 
thoroughly healthy, clean, wholesome individuals can 
with their nasal sieves strain out nine tenths of the 
germs that float in the air, choke them in their nasal 
mucus, and sweep them down the gullet to where the 
stomach will literally eat them alive. A certain amount 
of lowering of tone, of vigor and of vital resistance is 
necessary to allow the germs to get a foothold, particu- 
larly a permanent one, and it plays an important part 
in catarrh. This lowering of the vital tone is not solely 
in the nose, although the nose, for various reasons, is 
peculiarly susceptible, but is a general or constitu- 
tional condition that affects the nose as it does every 
other part of the body. In one sense it is quite true 
that, in popular language, catarrh is "in the system." 
Most fortunately, however, this fact, instead of com- 
plicating matters, simplifies them, for this lowering 
of resisting power, this slackening of vital tone in the 
nose, is chiefly and most commonly due to underven- 
tilation, overconfinement in hot, stuffy rooms, lack of 
vigorous exercise in the open air, underfeeding — in 
fact, to the very conditions that promote and increase 
the presence and infectiousness of germs. 

There is yet another way in which systemic or other 
conditions are believed to produce and promote ca- 
tarrh. We are all familiar with the promptitude with 
which, on exposure to cold, not merely our faces and 
hands, but the skin of our entire body surface, becomes 
first pale, then cold and, finally, almost wrinkled and 
goosefleshed. This means that the great skin mesh of 



CATARRH 133 

blood-vessels is emptying itself of its blood so as to 
preserve the warmth of the body. 

Unfortunately, at the same time that the skin is 
emptied of its blood and this blood is thrown into the 
internal organs, the purifying or excretory action that 
the skin was exercising upon it is stopped also. And 
this action, relatively slight, but appreciable and im- 
portant, has to be assumed by some of the internal 
surfaces of the body: lungs, nose, throat, liver, or food 
tube. 

If these happen to be perfectly healthy they can 
take up the additional burden of purification without 
difficulty; but if any one of them happens to be already 
a little overtaxed, or fighting against some irritant, 
such as dust, food-poisons, or germs, then this little 
overload is the proverbial last straw that breaks the 
camel's back, and we get a catarrh, a bronchitis, an 
attack of indigestion or even of jaundice. The strong 
probability is that to turn this into a real inflammation 
of any sort requires* the assistance of a germ; but there 
can be little doubt that the extra duties thrown upon 
the air passages and the food tube, our so-called " inter- 
nal skin," encourage attacks of cold and catarrh — - 
and this is the enemy against which the cold bath or 
splash is so useful. It makes little difference how cold 
water is applied, whether by splash, sponge, shower, or 
tub; the one thing needful is that the skin shall be 
given a sharp chill — enough to make you gasp slightly 
for a moment, as well as to make you acquire the habit 
of reacting promptly and of becoming, instead of 
colder, warmer than you were before. 



134 COMMON DISEASES 

It is not even necessary that the cold should be ap- 
plied in the form of water. Exposure of the body to 
cold, fresh air in one's room, accompanied by vigorous 
rubbing, will do almost as much good as the tub or the 
shower. The main thing is to get the skin, not merely 
of the face, hands, and arms, but of the entire body, so 
trained that it will react promptly to cold by becoming 
fuller of blood instead of emptier, and not " lie down on " 
the lungs and stomach, at least until the latter have 
had time to adjust themselves to the new load. The 
advantage of water over air in this performance is, of 
course, that it is cleansing as well as stimulating. It is 
not too much to say that a cool or cold splash-bath 
down to the waist every morning — and an all-over 
splash or tub is better yet — will do more to break up 
the cold habit and the catarrh tendency than almost 
any other single thing except sleeping with the win- 
dows wide open and living out-of-doors. 

The third factor, though fortunately not usually 
present, is very apt to be so in the most troublesome 
and obstinate forms of catarrh, and consists of defects 
or deformities of the nose. Some of these defects are 
the result of repeated attacks of the disease itself, such, 
for instance, as the now well-known polypi. These 
polypi are curious, spongy, gelatinous growths, in 
shape not unlike a lima bean and in size varying from 
this to that of a Blue-Point oyster, which in consistency 
and color they not distantly resemble. They are due to 
a watery, bulbous swelling of some part of the mucous 
membrane of the nose from repeated attacks of catar- 
rhal inflammation or the constant irritation of pus and 



CATARRH 135 

other discharges. As these oyster-like growths have 
few nerves and fewer blood-vessels, nothing can be 
done to them in the way of making them clear them- 
selves up or shrink; and the best thing is to remove 
them with specially-constructed forceps or wire snare 
— a perfectly safe and comparatively simple operation 
which usually gives great relief. It must, however, not 
be forgotten that they almost invariably result from a 
chronic, unhealthy condition of the mucous membrane 
of the nose and, if this condition be not corrected and 
kept so, other polypi will form and take the places of 
those that have been removed. 

Another very common condition is a hypertrophic 
or overgrown state of the turbinated bodies, the great, 
triple cushion -valves that bar out cold and dust. These 
by successive swellings and irritations have become 
so firmly thickened that it is practically impossible 
to get them to shrink to their normal size without 
puncturing them with an electric cautery or cutting 
away small portions of them. Every possible means, 
such as antiseptic washes, massage and local treatment, 
are used to restore to them their natural elasticity and 
get them shrunk down sufficiently to admit air for 
breathing purposes, without depriving them of their 
power of swelling up so as to exclude largely danger- 
ously cold or foul air. 

Ninety per cent of ordinary catarrh, while annoying, 
obstinate, and humiliating, is, fortunately, a relatively 
mild and harmless condition which may last for years 
and decades and never do its victim any serious or vital 
harm unless it should happen to extend up his Eusta- 



136 COMMON DISEASES 

chian tubes to his ears or downward to his larynx. One 
particular kind of catarrh, in which adenoids, or spongy- 
growths, are found in the pharynx back of the nostrils, 
is far the commonest cause of deafness and of ear trouble 
of all sorts in childhood ; while chronic, neglected catarrh 
of the nose is the foundation and starting-point of at 
least three fourths of the deafness of adult and later 
life. 

Another common cause of nasal obstruction and 
consequent catarrh is that known as deflections or 
bulgings of the septum. This septum, or partition, is a 
plate of cartilage, or gristle, combined with bone, which 
lies between the two nostrils, separating one from the 
other. This, normally, should be perfectly straight and 
flat, but actually, for some reason which we do not yet 
clearly understand, in a good many noses will be found 
bulged to one side or the other. Such bulging, of course, 
narrows the air passage on one side and expands and 
enlarges it on the other. These bulgings may become 
so abrupt and so extreme as to form folds or wrinkles, 
obviously interfering with the passage of air into the 
nose on the side toward which they project. 

Whatever the cause, the only practical remedy is to 
cut away, under cocaine or ether, the superfluous and 
projecting folds and portions of the septum, flatten or 
splint the remainder of it back into position, and restore 
proper shape and capacity to both nostrils. A variety 
of operations have been devised for this purpose, most 
of which give great relief. 

Another side-issue of catarrh which is worthy of 
mention is its extension, in the same manner in which 



CATARRH 137 

it attacks the nose and throat, to those curious air- 
spaces in the bones of the head known as the accessory 
sinuses. These are strange and somewhat unaccount- 
able air-bubbles, or hollows, in the bones of the face 
and head, without known function except to expand 
the bony framework of the face so as to enable it to 
protect the eyes. The two largest lie on either side 
of the nose, between the orbits above and the teeth 
below, their outer walls supporting the cheekbones. 
Another pair — the frontal sinuses — balloon out into 
the forehead just above the eyes; and a series of 
others — ethmoid sinuses — sprout back on either 
side and from the roof of the nasal passages toward 
the base of the skull. They have no known function, 
but they are lined with mucous membrane and are 
filled with air which reaches them through narrow 
openings from different parts of the nasal passages. 

Obviously, they furnish ideal disease-traps, for a 
comparatively small amount of swelling of the mucous 
membrane of the nose will block the narrow and irreg- 
ular openings through which they empty into it, and 
if once a germ or some of its products forces its way into 
them they make model breeding-chambers, with almost 
no possibility of escape for the mucus or pus. 

Naturally, little that is definite or of any wide appli- 
cation can be said in regard to the cure and treatment 
of a disease like catarrh, which depends upon the coop- 
eration of so many scores — yes, hundreds — of dif- 
ferent influences and causes, both external and internal. 
One thing, however, may be frankly said to relieve the 
pessimism in many minds as to the incurability of 



138 COMMON DISEASES 

catarrh, and that is that at least ninety per cent of it is 
curable under competent individualized treatment and 
attention. Perhaps it would be more nearly correct to 
say that nine tenths of the sufferers rather than nine 
tenths of the disease can be cured. Innumerable as are 
its causes, catarrh's victims all belong to one species of 
animals, homo sapiens, and the general line of pro- 
cedure to which we have referred — that of cleansing 
the air and the surroundings generally and so increas- 
ing the vigor of the patient — will prevent nine tenths 
of all catarrh and either cure or markedly relieve eight 
tenths of all existing cases. For prevention and per- 
manence of cure, general treatment by fresh air, cold 
bathing, food, and exercise is much more important 
and reliable than are local measures. 

Where local damage has already been done this must 
be corrected by intelligent nasal treatment, at the same 
time that the patient is being trained in good habits of 
life; so that, when the old indebtedness is wiped out, 
he will not pile up a new one. Mildly antiseptic and 
alkaline washes and sprays, particularly those that 
most closely resemble the serum, or watery part, of the 
blood in their density, and which mechanically flush 
out and cleanse the nose until it is in a position to 
flush and cleanse itself, are the most useful local reme- 
dies. 

Then come stimulating powders or applications, 
particularly such as are mildly antiseptic and do not 
injure or attack the delicate mucous membrane, but are 
just strong enough to produce a profuse flow of mucus 
and thus empty out the congested and swollen mucous 



CATARRH 139 

membrane and turbinated bodies. The use of these, 
however, requires great skill and judgment, for they 
should be just irritating enough and used just often 
enough to make the nose flush itself out, without set- 
ting up an irritation on their own account; as nearly 
all of them do if used indiscriminately or put into the 
patient's own hands. Direct massage of the turbinated 
bodies by means of absorbent cotton on the tip of 
a probe is also most useful. Also, such portions of 
the mucous membrane or the valve cushions of the 
turbinated bodies as have become hopelessly diseased 
should be actively treated or removed; bulges and spurs 
upon the septum corrected or cut away; sinuses that 
are full of pus opened, washed out, and drained. When 
these defects have been corrected, and the patient has 
been taught to be as "finicky " about the cleanliness of 
his air as he is about that of his food, ninety per cent 
of all cases of catarrh, however obstinate, can either be 
cured or made compatible with fair health, comfort, 
and efficiency. 



CHAPTER VII 



ASTHMA AND HAY FEVER 



SOME men are born asthmatic; some achieve 
asthma; some have it thrust upon them! While 
all asthmatics are mentally in the last class, a majority 
are physically in the first. Asthma and hay fever both 
are vivid illustrations of that unfortunate class of ills 
to which the flesh is heir, in which it is the patient that 
makes the disease. There is, of course, the external 
match which fires the mine; but to cure the disease it is 
not enough to remove this external cause, you must 
remodel the victim if you can ! 

Perhaps this sounds rather discouraging for a begin- 
ning; but, like every cloud, it has a silver lining, or at 
least a silver-plated one. Even though — just as Bos- 
ton is not a place, but a state of mind — asthma is not 
a disease, but a state of body, the fact has certain re- 
deeming features . If you were born asthmatic you stand 
a good chance of dying asthmatic, but you are pretty 
safe to live fifty or maybe seventy-five years in between. 
You may sneeze your very soul out, and gasp until you 
think every breath will be your last; but it will very, 
very seldom kill you, though there may be times when 
you wish it would. 

Further, and most consoling, even bodily make-ups 
can be remolded and remodeled by persistent and 



ASTHMA AND HAY FEVER 141 

intelligent pressure to an astonishing extent nowadays. 
If the explosive tendency in lung or nose be one of 
your bodily traits it has to take its chances with your 
other characteristics in the internal struggle for exist- 
ence, and it may prove feebler and shorter-lived than 
any of them. In fact, this broad consolation can usu- 
ally be offered to a large majority of hay-fever sufferers 
and a considerable share of asthmatics. Every year 
after the age of forty tends to weaken the grip of the 
disease, and those who have sneezed regularly every 
year in their youth or gasped every day for months at 
intervals through their young adult life will, in middle 
or later life, escape from their bondage with little more 
than an annual "rose cold," dust-sneezing, or an occa- 
sional wheezy cold or stuffy bronchitis. 

The general belief that all diseases tend to become 
worse with advancing years, and that our resistance to 
attack and powers of recovery grow less and less with 
each reach of the river of time down which we drift, is 
fortunately far from true in a great many instances. It 
is one of the many compensations of maturer years 
that with those years we actually acquire an immunity 
from scores of disease attacks and disturbances to 
which we fell an easy victim in early life. We become 
seasoned veterans in life's campaign. The latter part 
of middle age and even old age itself, though periods of 
narrower scope of bodily activities, are often freer from 
pain and actual discomfort than the oft-apostrophized 
"happy days of childhood," with their pains and colics 
and cut fingers, both literal and metaphoric. This is 
the physical basis of Wordsworth's "years that bring 



142 COMMON DISEASES 

the philosophic mind." We don't react so violently, 
not to say explosively, to our environment. We are 
more comfortable if less ecstatic. We have shed our 
passions and acquired in their stead reasonable likes 
and respectable prejudices; less exciting, but far more 
comfortable to live in the same house with. W T e can 
take longer and hence more cheerful views of the uni- 
verse. Particularly is this true of those disturbances 
and discomforts due chiefly to a peculiar sensitiveness 
or susceptibility of our nervous systems, which are 
grouped together under the name "neurotic." Their 
victims appear to have their nerves on the outside of 
their skins, as it were, instead of underneath. They liter- 
ally "wear their hearts upon their sleeves for daws to 
peck at." 

And every peck produces an explosion. Some of 
these susceptibilities are, of course, the indications and 
starting points of serious nervous or mental disturb- 
ance, but many of them are little more than a "thin- 
skinnedness" — an excessive tenderness and softness 
of both bodily and mental cuticle which make every 
rasp against its environment an agony. In such cases 
— and they are in a great majority — the cuticle 
toughens naturally and healthfully with advancing 
years, and many a man or woman who suffered tor- 
tures in childhood and young adult life from sick- 
headaches, neuralgias, nervous dyspepsias, palpita- 
tions of the heart, insomnias, fits of depression and 
discouragement, premonitions that they are not long 
for this world, will gradually grow calluses over his 
nerve-tips, strike a condition of balance, attain a con- 



ASTHMA AND HAY FEVER 143 

dition of health and comfort in middle life, and live to 
a good old age. 

Asthma and hay fever both belong to this neurotic 
or "touchiness" group. Their body gasoline, as it 
were, has been turned out with too low a flash-point, 
so that a trifling rise of temperature will ignite it and 
cause an explosion in nose or lungs. The asthmatic and 
the "hay-feverite" are born — not made — that's 
why they last so long ! But as a compensation the hay- 
feverite enjoys a complete respite from his disease and 
usually excellent health from ten to eleven months out 
of the year. Ultimately, in nine cases out of ten, he 
outlives his disease completely. 

The asthmatic seldom suffers more than from one 
tenth to one fifth of his time, is seldom prevented from 
conducting his affairs with efficiency, is practically 
safe to keep on living and wheezing for from thirty to 
fifty years, and has at least a two-to-one chance of 
outliving his disorder, which is literally, in more senses 
than one, a short-winded disease. 

What we don't know about asthma would fill vol- 
umes, yes, whole libraries ! But out of the welter and 
the whirl certain outlines are slowly rising, vague and 
somewhat indefinite as yet, but fairly reliable as a basis 
for future knowledge. While, as in the case of asthma, 
we do not yet know the cause of the disease and hence 
can do little radically to cure it, we do know a good 
deal about its history and its responses to certain influ- 
ences, so that we can do much to modify and relieve it. 
We can very frequently cure asthma in the sense of 
stopping the attack and preventing its return for 



144 COMMON DISEASES 

months and even years, and each time we are able to 
do this after forty years of age there is a better chance 
that the disease tendency will die out of itself in the 
interval, and the relief be permanent — the patient be 
cured as well as the disease. 

One island which is rising out of the fogs of the half- 
knowledge that envelops both these diseases is that 
asthma is not so much a disease of the lungs, or hay 
fever of the nose, as of one of the nerves supplying both 
these organs, and especially that group of nerves which 
is concerned with the control of the blood vessels and 
the blood supply, and hence known as the vasomotor 
nerves. Surprising as it may seem, neither of the 
diseases shows any very strong tendency to give rise to 
permanent or serious disease, such as chronic catarrh 
of the nose or tuberculosis of the lung. In both of them 
the extraordinary feature is that the delicate mucous 
membrane lining both the nose and lung may be, and 
usually is, in apparently perfectly healthy condition a 
few hours before and a few days or weeks after the at- 
tack. In both cases it is not an inflamed or diseased or 
congested condition which gives rise to the agonizing 
discomfort and sense of suffocation, but an extraordin- 
ary and abnormal susceptibility or "touchiness" of 
either nose or bronchial tubes. This makes them re- 
spond to the touch of some trivial irritant like pollen, 
dust, or peculiar smell, or a whiff of smoke, wind, or fog, 
by a furious explosion. First there is a sudden puffing 
up and swelling, and this is followed by spasms of all 
the muscles in the neighborhood. A soothing spray in 
the nose, a whiff of chloroform, a puff of the fumes from 



ASTHMA AND HAY FEVER 145 

niter paper, and the whole cyclone of wheezing, sneez- 
ing, and suffocation subsides as quickly as it came up. 
In fact, our greatest difficulty in finding out anything 
definite about the causation of asthma and hay fever 
was that patients never died of the latter and very sel- 
dom of the former, so that we had no opportunity of 
postmortem examinations. More puzzling yet, in those 
rare cases in which asthmatics died from some acci- 
dental cause during or just after a paroxysm their 
lungs were found to be in an almost normal or healthy 
condition, except a slight catarrh of the bronchial tubes 
of no greater severity than might have accompanied 
an ordinary influenza. Like rheumatism, there are few 
diseases that can produce so much distress and discom- 
fort with so few serious or fatal results as do hay fever 
and asthma. Yet, for all that, often they make their 
victim wish he could die. 

Of course, these hysterical spasms of their blood 
supply don't do either nose or throat any particular 
good. If they continue long unchecked, especially if 
the vigor or the general health of the victim becomes 
impaired from some other cause, they sometimes fur- 
nish a favorable seed-bed for one or the other of the 
milder infectious germs which are always prowling 
about, seeking whom they may devour, and we get a 
chronic catarrh in the one case and a chronic bron- 
chitis in the other. These, however, like the condition 
upon which they are grafted, are pitched in a minor 
key, are usually mild in character, slow and exceed- 
ingly chronic in course, and seldom have serious or 
fatal results. 



146 COMMON DISEASES 

The widely-accepted belief that asthma tends to run 
into consumption has really but little foundation. 
Asthmatics may, of course, develop consumption, as is 
not surprising, considering that consumption kills from 
one tenth to one seventh of all those who die, but there 
is no evidence to show that they do so with any greater 
frequency than the average of non-asthmatic individu- 
als. Indeed, many physicians with wide opportunities 
for observation believe that the asthmatic is actually 
less likely to develop tuberculosis than is the ordinary 
individual and sometimes enjoys a kind of "honor 
among thieves" immunity from this dread disease. 
Certainly it is rather uncommon to see a well-marked 
asthmatic become consumptive. Here is another little 
flake of silver lining for the asthmatic's cloud — a con- 
solation to which he is legitimately entitled. 

It is not to be wondered at that this belief should 
have grown up, for any one seeing an asthmatic at the 
height of one of his paroxysms of gasping and suffoca- 
tion, with bulging eyes and straining muscles, is ready 
to believe him about to fall a prey to any form of fatal 
lung disorder. His one doubt about the likelihood of 
developing anything worse would be in the nature of 
the small boy's confident assurance that lightning never 
struck twice in the same place, "cause it did n't need 
to." One such calamity as asthma is enough for one 
human body! Some of the supposed connection be- 
tween asthma and consumption has undoubtedly 
grown up from the very common, pathetic attempt on 
the part of the sufferer from tuberculosis to disguise 
from himself and his friends the seriousness of his ail- 



ASTHMA AND HAY FEVER 147 

ment by calling it asthma. So frequently is this done 
in the milder and longer-lived forms of the disease that 
in the far West, around the health resorts, " California 
asthma" or "Arizona asthma" is the vernacular term 
for consumption. But most fortunately the catarrh 
that develops after prolonged hay fever disappears 
when the hay fever stops, and the bronchitis which is 
grafted upon asthma will usually clear up or sink to 
comparative unimportance when the progress of the 
asthma is checked. So, if you have any sporting blood 
in your veins you need not hesitate in taking'your 
chances with either. Anyway, most of us have to have 
something in the way of a handicap, whether mental or 
physical. 

xAnother group of facts that go to support this nerve- 
explosion, "touchiness" theory of asthma is that asth- 
matics are exceedingly apt to be subject to other ex- 
plosions of some character, such as nettle rash or hives 
after eating particular articles of food, sudden attacks 
of colic or indigestion from the same cause or without 
any ascertainable cause, painful puffings and redness 
over the joints — sometimes set down as gouty, some- 
times as rheumatic — various neuralgias and sick- 
headaches. A considerable majority of asthmatics 
suffer from pains and "touchinesses" of this descrip- 
tion. 

Not a few asthmatics are subject to attacks of hives, 
which may even alternate with their asthmatic at- 
tacks, one seizure apparently taking the place of the 
other. Indeed, our most vivid and probably most accu- 
rate characterization of asthma was that of Sir Andrew 



148 COMMON DISEASES 

Clark — "hives of the bronchial tubes." If we could 
look into the lungs of the asthmatic when he is gasping 
and wheezing for breath we would very probably see a 
crop of itching swellings all over their lining membrane, 
swellings not unlike the familiar red and white wheals 
of hives, modified, of course, by the fact that they 
occur in the soft permeable mucous lining instead of on 
the firm, tough skin. At all events, "hives in the lungs " 
describes well what it feels like. Moreover, many 
asthmatics will tell you on close questioning that some 
particular odor, like that of flowers or horses or dust, 
some particular change in the weather, like fog or frost, 
some special article of food, like strawberries or cheese, 
or even some unpleasant mental impression or exasper- 
ation will bring on one of the attacks of wheezing and 
gasping. Not a little of the well-known beneficial 
effects of a change of climate or even of the house is 
due to getting away completely from the peculiar local 
odors of the neighborhood, the customary food, the 
monotonous round of daily duties with their recurring 
irritations, and the ever-recurring changes of temper- 
ature, moisture, and wind which gradually, and often 
unconsciously, have "got on the nerves" of the pa- 
tient. Regrettable but true it certainly is, that when 
once the charm of novelty has worn off the new climate, 
the cure which the change has effected is likely to fol- 
low suit, although a fair proportion of these climatic 
cures are permanent. 

A peculiar "touchiness" to some external irritant is 
the underlying basis in both hay fever and asthma; but 
though there be this inborn sensitiveness, it will not, so 



ASTHMA AND HAY FEVER 149 

to speak, explode of itself; it must be acted upon by 
some influence from without. Also, in most cases a fuse 
is required to convey the fire to the mine, so that we 
are beginning to find that almost every case of asthma 
stands, as it were, upon a tripod. Thus we have an 
internal mine of irritability, an external spark of odor, 
dust, fog, or what not, and, between the two, a fuse or 
irritable spot in nose, throat, stomach, or lung, on which 
the spark must fall to reach the powder. 

Now, remembering the figure of the tripod, it is ap- 
parent that if you break any one of the legs of a tripod 
it topples over, and upon such a plan of strategy our 
campaign against asthma and hay fever is conducted. 
First, we search out and remove the external irritating 
influence, keep the spark from falling on the fuse. 
Second, we go over the entire body, but particularly the 
regions mentioned, and endeavor to discover the sensi- 
tive, inflamed, or otherwise diseased structure or area 
which serves as the tinder and fuse for the spark. 
Third, we build up the general vigor, balance, and re- 
sisting power of the entire system in every possible 
way. And thus we neutralize the explosive tendency. 

Let us take the case of hay fever first, both because 
here the three factors can be more readily seen and 
separated, and also because a fair measure of success 
has already begun to attend our efforts for its relief. 
Here we have, as its name implies, a disturbance which 
brings the tears of agony to the eye in the balmiest and 
most radiant period of the year, the leafy month of 
June! The month in which we have the most delight- 
ful, ambrosial, and poetically -wholesome of all odors, 



150 COMMON DISEASES 

the scent of new-mown hay. As we know the malady 
on this side of the Atlantic, however, its name appears 
to be a misnomer; for, although its victims may experi- 
ence trivial sneezing and redness of the eyes in May 
and June, its most exquisite agonies are reserved for a 
later and less delightful season of the year — from mid- 
August to early October. This is the stranger because 
hay fever is popularly regarded as distinctly an Ameri- 
can disease, and, judged by the number of victims and 
vigor of its manifestation, this doubtful honor cer- 
tainly belongs on this side of the Atlantic. But, like 
many others of our institutions, both good and bad, it 
was, in a sense, imported, or, at all events, was first dis- 
covered in Europe; and as the time of the year there 
at which the largest amount of irritating pollen and 
"sneezy " odors are abroad is early in the summer, and 
the pollen most active in its causation, that of the 
meadow hay (Anthoxanthum odoratum), it was pro- 
perly and correctly termed: "Hay Fever." 

When, however, the possessors of this exquisite 
poetic temperament, this capacity for "fine frenzy" on 
the part of their nasal mucous membrane, emigrated 
to this country or were born here with that precious 
heritage, they found that the pollen of our meadow 
grasses was not sufficiently irritating. But as this de- 
ficiency was more than made good by the pungent 
though utterly unpoetic pollen of certain of our late 
summer flowers and weeds — notably the familiar 
"ragweed " {Artemisia ambrosifolia) , and goldenrod 
— they promptly transferred their periods of explosion 
to this later date. The disease was bad enough without 



ASTHMA AND HAY FEVER 151 

adding to its injury the insult of suffering from "rag- 
weed fever," so the European name was allowed to 
stand. 

The first means of escape from this plague which 
suggested itself was, naturally, an exodus. It began 
at once and continues still, so that we have all seen it 
scores of times. The smitten ones rushed madly as 
though the angel of pestilence were upon their trail, 
fleeing up to the mountain-tops, down to the seacoast, 
to the mosses and hemlocks of the North Woods or the 
sands of the Dry Tortugas; to the green prairies of the 
Mississippi valley or the purple deserts of Arizona — 
anywhere, anywhere ! to escape from the farmer and his 
plow. And most of them got relief. It was a matter of 
indifference where they went, so long as they got away 
from the plow-land with its grasses and parasite weeds, 
whether a barren island out at sea or a dusty desert on 
the shoulders of the Rockies or Sierras. But "the vil- 
lain still pursued them." Not only had they to reckon 
with the relentless onward march of civilization climb- 
ing the mountains, clearing the forests, irrigating the 
deserts, with the rag- weed trotting along behind it, like 
a yellow dog under the wagon, but they carried the seeds 
of it in their own pockets, as it were. No sooner did 
a stretch of primitive forest or mountain-top or desert 
island begin to get a reputation as a hay-fever resort 
than enterprising persons promptly proceeded to build 
camps and hotels and boarding-houses for the ac- 
commodation of the sufferers. With the boarding- 
houses came inevitably garden patches, broadening 
to wheatfields and cornlands, even though the}' avoided 



152 COMMON DISEASES 

the deadly hay; and, one fine day, the asylum was 
broken, the pure air was tainted, and the health re- 
sort had to fall back on ordinary summer boarders 
for its profits. 

A puzzling feature of the disease was that the results 
attained at these resorts varied widely in different 
individuals. Some would get relief, year after year, in 
the very same spot in which others would find their 
days one continued torture, and vice versa. A, who 
could n't get any relief at all at B's favorite resort, 
would go to another apparently no better in point of 
remoteness from hay -fields, and get immediate relief . 
This, coupled with the fact that the first round of 
sneezing in the yearly paroxysm would begin at mid- 
night or at dawn of the tenth, fifteenth, or twentieth 
of August every year, gave ground for the belief that 
there was a strong mental element in the disease, and 
that suggestion and expectancy had a great deal to do 
with its attacks. Now, however, this has gone by the 
board completely, for it has been discovered that, 
while most hay-fever sufferers will react promptly to 
the pollen of any one of three or four flowers, such as 
rag-weed, asters, goldenrod, not a few of them will re- 
spond to the pollen of one flower and to that alone. 
So that, if this particular flower happens to be ab- 
sent from the gardens, fields, and roadsides of a dis- 
trict, they may pass through August and September 
unscathed, even though wading through seas of rag- 
weed or goldenrod. 

On the other hand, if their " bete noir" happens to be 
present among the native or imported flora of a hay- 



ASTHMA AND HAY FEVER 153 

fever resort, immunity will be a mockery and a delusion 
to them. Similarly, the almost calendar-like precision 
with which attacks will begin at or near a certain date 
each year is due to the closeness with which the blos- 
soming of a particular flower will approximate to the 
same date each successive year. Just as the peculiar 
alternating rhythm of malaria was found to be due to 
the breeding cycle of the parasite that produces it, so 
the yearly rhythm and the extraordinary coincidences 
of hay fever are due to the blossoming of the flower 
whose pollen causes it. Mental influence is a great thing 
in some fields, but it has little to say in pathology. 

But while civilization was destroying one refuge for 
the hay -fever sufferer with the best of intentions in the 
world, it was, without any intention at all, building up 
another one in the shape of those artificial deserts of 
brick and mortar — our great cities. In the heart of 
these one can be just as free from the flowers, pollen, 
and fragrant odors of the deadly country as upon the 
remotest mountain peak. Scores of hay-fever victims 
now can find surcease from their sneezing and dry their 
tears by plunging into the heart of the downtown 
district of New York, Philadelphia, or Chicago, where 
even the dust and the clang and the heat seem to them 
a small price to pay for relief from torture. And what- 
ever other floral dangers roof-gardens, amusement 
parks, and summer theatres may contain, hay and its 
products are conspicuous by their absence. So that, 
with mountain-tops at one extreme and skyscrapers at 
the other, the hay-feverite who can afford the price of 

a ticket and can take his vacation in August, which is 

• 



154 COMMON DISEASES 

fortunately the easiest season of the year to do this, 
usually can get fair relief from his temporary affliction. 
Meanwhile, medical science had not been idle. Its 
first attack was upon the second leg of the tripod — the 
fuse or tinder upon which the pollen spark must fall 
to provoke the explosion. As this was obviously in the 
nose, a thorough campaign of nasal renovation and 
spring cleaning was begun at once. The results were 
encouraging. Many hay-fever victims were found to 
have marked abnormalities or diseases of the nose, such 
as tumors, chiefly polypi, bulgings and spurs upon the 
septum — the plate between the two nostrils — swol- 
len turbinates, and special sensitive spots in various 
parts of the interior of the nose, the simple touching of 
which with a probe would bring on a furious attack of 
sneezing. Upon removing these growths and correct- 
ing the displacements of the septum or cauterizing 
these sensitive spots, fully one third of our hay -fever 
sufferers were markedly relieved, and some of them 
cured. It was further found that there were a variety 
of drugs which had the power of either deadening the 
sensitiveness of the mucous membrane of the nose or 
constricting its blood vessels so as to prevent the in- 
tense swelling. These drugs, if skillfully and intelli- 
gently used just before the expected date of the at- 
tack, would either abort it or keep it within very 
moderate bounds, so that the patient could still go 
about his work. A few of these, such as weak solutions 
of morphine and cocaine, though very effective for a 
time, were found to be only temporary in their effect 
and also exceedingly dangerous on account of their 



ASTHMA AND HAY FEVER 155 

poisonous effects and habit-forming possibilities. They 
were, therefore, abandoned by the profession except as 
a mere temporary means of relief to prepare the way 
for more radical and permanent treatment. But the 
knowledge of their effects has got abroad, and they, 
unfortunately, form the active principles of most of the 
advertised hay-fever and asthma remedies, whose ulti- 
mate effects are often literally worse than the disease ! 

There remain, however, a number of safe and fairly 
effective remedies, chiefly in the nature of constrictors 
of the blood vessels or soothing alkaline washes and 
unirritating local antiseptics, whose intelligent adjust- 
ment in skilled hands to each particular case will often 
give a very considerable measure of relief. In a disease 
like hay fever, which is usually limited to a certain 
definite and distinct period in the life of each individual, 
any means which can be devised to keep each success- 
ive attack within reasonable bounds of comfort and 
efficiency may be regarded as, for practical purposes, 
a fairly satisfactory cure, though leaving much to be 
desired on grounds of comfort. 

But science had still another string to its bow. It 
has literally grasped the nettle and is engaged in a 
determined and already rather encouraging effort to 
wrest from the poison itself an antidote for it. Oddly 
enough, the most promising results thus far have come 
from the side of the Atlantic which suffers least from 
the disease. A European specialist, Professor Dunbar, 
had been experimenting in most painstaking fashion 
for years with pollen from scores of different plants 
suspected of causing hay fever, to discover which was 



156 COMMON DISEASES 

the real criminal. By careful experiments, first upon 
himself and then upon other volunteers, he determined 
positively that the attack of hay fever was produced 
in those susceptible to it by the pollen of seven or eight 
grasses and flowers, some of "which have been already 
mentioned; and that no other pollen and no ordinary 
dust, however irritating, would produce these symp- 
toms. As these pollen grains were covered with tiny 
spurs and prickles it occurred to him that possibly 
these, by their mechanical irritation of the mucous 
membrane, might be the cause of the trouble. But this 
possibility was disposed of by finding that water in 
which pollen grains had been steeped and crushed, 
when dropped into the eye or sprayed into the nostril, 
would produce an attack as promptly as the grains 
themselves. Obviously, then, there was some irritat- 
ing principle contained in the pollen which produced 
hay fever. The thought occurred to him that if other 
poisons injected into animals will produce an antitoxin, 
why not this one? Xo sooner said than done! He in- 
jected rapidly -increasing doses of pollen into horses 
and dogs, took the filtrate of their serum, dropped it 
into the eye of a patient suffering the agonies of hay 
fever, and was delighted to find that it gave prompt 
relief. The remedy is still on trial, but reports from 
some two thousand cases in which it has been used 
show that it gave marked relief, and relief of a more 
permanent character than that of any other previous 
remedy, in about fifty per cent. 

When it is remembered that hay fever is a peculiarly 
individual and personal disease, and is produced by 



ASTHMA AND HAY FEVER 157 

the pollen of twelve or fifteen different flowers and 
plants, it is of course unlikely that any single antitoxin 
would prove to be curative for more than from one 
third to one half of all cases. But we have every reason 
to hope that, when ten or twelve different forms of 
antitoxin against as many different kinds of pollen 
have been developed, the majority of sufferers will be 
able to find in some one of them a considerable measure 
of relief. 

The case of asthma is similar to that of hay fever, 
only more chronic and less cheerful ! The two diseases 
are so similar and so closely allied that asthma might 
be defined as a sort of periodic, lifelong hay fever, 
without relation to season or climate; and hay fever 
as a temporary, seasonal asthma. Almost any attack 
of hay fever that lasts long enough, beginning with 
sneezing and weeping at the eyes, develops into spasms 
of gasping and wheezing which are absolutely indis- 
tinguishable from asthma except that their cause is 
known. In addition to this, not a few who suffer from 
hay fever in early life develop asthma in later life, 
though this is usually one of the milder forms, and 
many sufferers from all-the-year-round asthma are 
subject to hay fever. In fact, the strong probability 
appears to be that asthma is a hay fever of the lungs, 
of which the cause has not yet been definitely discov- 
ered. Both diseases occur in the same neurotic, gouty, 
nettle-rashy type of individual and seem to have rather 
a preference for the higher walks of life. Both are 
relieved by the same class of remedies, chiefly nerve 
sedatives and blood-vessel constrictors. Both are due 



158 COMMON DISEASES 

to a spark falling upon tinder which transmits it to the 
powder; only, in the case of asthma the charge of pow- 
der is bigger and more easily inflammable, and both 
the spark and the tinder fuse are more difficult to dis- 
cover and less important. In fact, in many cases any 
one of three or four different kinds of sparks may be 
sufficient to produce the explosion, and occasionally 
the asthma gun seems to get into a cheerful automatic 
habit of going off of its own accord. The fight against 
hay fever is a mere summer campaign; that against 
asthma is a Thirty Years 9 War ! 

Our artillery is directed against the legs of the same 
tripod as in hay fever, only the thing seems to have a 
provoking ability to stand on one leg. Even when we 
have excluded the spark and destroyed or dampened 
the tinder fuse, the asthma infernal machine in the 
lung, of its own sweet accord, will continue to explode 
at intervals. The attack of asthma is one of the most 
striking and unmistakable in the realm of medicine. 
The patient will be sitting quietly conversing or work- 
ing, or he may have retired and be sound asleep, when 
suddenly he becomes conscious of a sense of tightness 
and constriction in his chest and throat. He tries to 
relieve this by breathing deeply, but instead of getting 
his breath again the sense of suffocation increases until 
it becomes almost intolerable, in some instances pro- 
ducing a fear of impending death by suffocation. The 
sufferer gasps for breath until his chest is pulled up into 
a condition of extreme expansion, then runs to the 
window or leans forward and clutches the top of a 
chair or the foot of the bed, as if to pull himself up out 



ASTHMA AND HAY FEVER 159 

of the bog in which he is smothering. Then, when his 
chest has been distended till it can hold no more, the 
rhythm of his breathing undergoes a curious change. 
Instead of his loudest gasp and intensest effort being 
concentrated on the attempt to breathe in air, by a 
strange reversal his inspirations become short and 
ineffective, while his expirations are enormously pro- 
longed and wheezing and difficult. Although he is still 
suffering from an agonizing sensation of shortness of 
breath, his principal difficulty, to a spectator, now ap- 
pears to be in emptying his lungs of the air which he 
has drawn into them. His face becomes red and suf- 
fused, his eyes bloodshot, and, in extreme cases, his lips 
purple or blue. In fact, to all appearances he is in the 
very act of strangling to death. Yet this extraordinary 
and agonizing performance will go on, not merely for 
minutes, but for hours at a stretch, without bringing 
him one whit nearer to death or relief. His gasping, 
labored breathing is interrupted at intervals by a short, 
sticky, aggravating cough. This gradually loosens 
and, about the time that the paroxysm reaches its 
height, which may be anywhere from twenty or thirty 
minutes to five or six hours — usually about two or 
three hours — the cough becomes looser and expecto- 
ration sets in. 

As soon as this has occurred the paroxysm begins to 
subside, and most veterans of repeated asthma cam- 
paigns will assure you that if they could just get this 
mucus out of their lungs, and get the cough loosened 
up, they know that the paroxysm would subside at 
once. It is, however, almost certain that the cough and 



160 COMMON DISEASES 

the free expectoration later are merely symptoms — 
first, of the hot, itchy, dry, hivelike swelling which is 
taking place in the bronchial tubes; second, of its sub- 
sidence and the leaking out of fluid serum. When- 
ever an attack is aborted, as it often can be at a 
very early stage, the whole trouble will subside without 
the appearance of any expectoration of any import- 
ance. 

Few things are more distressing either to experience 
or to watch than a severe paroxysm of asthma, yet an 
old asthma veteran will have the coolness and sang 
froid to punctuate the momentary intervals between 
his desperate gasps for breath with casual and even 
cheerful conversation. He is wretchedly uncomfortable, 
but he knows he is not going to die and that the attack 
will pass off in a few hours, whatever he does or does- 
n't do. Meanwhile, the cooler he can keep the better 
off he will be. 

Now when you have this sort of "battle, murder and 
sudden death" descending upon you every day for two 
or three weeks at a stretch, with the knowledge that 
when it leaves you you will probably have an inter- 
val of from two to six months, but that Heaven only 
knows when that interval will come to an end and 
another cyclone sweep down upon you, when you 
know this it can readily be seen that life with asthma 
is not exactly "one grand, sweet song!" The marvel 
is that asthmatics stand it so bravely and philosoph- 
ically. 

While asthma, like necessity, knows no law, the at- 
tacks have a decided tendency to occur either in the 



ASTHMA AND SAY FEVER 161 

late evening or during the night, often having the 
cheerful habit of waking their victims out of a sound 
sleep about midnight. 

Much the same lines of defense .are open to the asth- 
matic as to the hay-feverite, but the weapons are far 
less effective and the outlook for victory more remote. 
The principal cause of the disease is the patient him- 
self, and you can't very well either remove or elimin- 
ate him. The outlook for life is, of course, excellent. 
The asthmatic does not exactly bear a charmed life, 
though to watch him in some of his paroxysms you 
would think he did. But he does have a distinct tend- 
ency to l\ve well on into middle life and often to a 
good old age, although he may, in the language of the 
apostle, " die daily." One consolation for the asthmatic 
is that death should have no terrors for him — he has 
suffered more in a handful of his paroxysms than nine 
tenths of the dying ever do. 

Furthermore, the toughness and adaptability of 
the human constitution is something astounding, and 
while no one ever gets to enjoy asthma — as eels are 
said to get used to skinning — they do manage to stand 
an astonishing amount of torture and annoyance from 
it without either losing their efficiency or their happi- 
ness. Taking the toughness of the average asthmatic 
constitution into account, the outlook is an encourag- 
ing one to the extent that by careful and intelligent 
modification of the sufferers' health, surroundings, 
climate, and habits of life, combined with the skillful 
utilization of such remedies as we possess, a large major- 
ity of asthmatics can be brought into a state of com- 



162 COMMON DISEASES 

parative comfort, with the prospect of outlasting 
their disease. 

Oldest and probably most effective is the method al- 
ready alluded to in , hay fever — change of climate. 
Precisely how this helps the sufferer we are still unable 
to say. Probably, as already suggested, it does so by 
removing him from all the petty physical, mental, and 
social irritations which, though harmless to normally 
thick-skinned individuals, "get on his nerves." One 
thing is fairly certain — a change is the principal thing, 
for every variety of climate yet discovered has been 
found to cure some sufferer of his asthma. But, of 
course, the change, in order to give permanent relief, 
must be for life, or, at all events, for a number of years 
instead of for a month or two as in hay fever. And like 
many other climatic improvements of health it is apt 
to diminish after the novelty wears off, so that many of 
this class of health seekers who have gone from New 
England to Minnesota, after a few years of complete 
relief, have been compelled again to take up their 
traveler's staff and go to the mountains. From their 
period of respite in Colorado they have been driven on 
to California; from there to Arizona and then down into 
Mexico. So that the word of warning to all who seek 
cure of asthma by change of climate is: first, to try 
how much good you can get by temporary changes of 
climate in various places within easy reach; second, if 
you get complete relief in a region, test it for at least 
six months and preferably a year before deciding to 
remove to it; third, make your removal in such wise 
that you will be comparatively footloose to undertake 



ASTHMA AND HAY FEVER 163 

another exodus in three or four years' time should your 
condition demand it. After all, a change of climate is 
the best, most reliable and most wholesome and health- 
ful cure as yet known for asthma. Probably from one 
fourth to one third of all who resort to it, under intelli- 
gent advice and proper precautions, gain more or less 
permanent relief, and about half as many effect perma- 
nent cures. 

The intelligent utilization of a modified form of 
change, such as changing from one house to another 
whenever the attacks come on, or even by having rooms 
in different parts of a county and moving from one to 
the other, will often make life fairly tolerable, even 
though it may not entirely relieve. There are thousands 
of healthy and prosperous people scattered all over the 
West, the Northwest, and the Pacific Coast who will 
tell you that they came out there originally for their 
asthma and either got entirely rid of it or reduced the 
frequency and severity of their attacks to such a de- 
gree as to make life happy. That 's as much as most 
people can expect even with the best of health ! 

Another line of defense is that of endeavoring to 
discover and remove the external irritant that starts 
the sensitive lung to swelling and burning and wheez- 
ing. This, unfortunately, is a good deal like hunting 
a needle in a bundle of hay; yet patience will often do 
wonders with it, and in a fair though not very large 
percentage of sufferers they and their medical advis- 
ers together will be able successfully to ferret out the 
often apparently insignificant and even absurd irritant 
which set off the explosion. As in the case of hay fever, 



164 COMMON DISEASES 

the commonest of these irritants are smells and odors 
of different sorts, sometimes those of flowers or grasses, 
not infrequently those of horses, cats, dogs, or other 
animals. Sometimes it will even be the odor of a par- 
ticular room, house, carpet, or garment. One asthmatic 
was reported to me by a colleague whose paroxysms 
were brought on by the odor of a Navajo blanket used 
as a hanging in her bedroom. 

Next most common, but more difficult to discover, 
are particular articles of food, especially such as pro- 
duce attacks of hives in susceptible individuals, like 
strawberries, shellfish, cheese. Lastly, but less fre- 
quently involved, are certain climatic changes like fog 
or frost or dry, dusty winds or the smoke from a leaky 
stove or drafty chimney. 

Then we have to search for and attack the fuse or 
tinder, and this, as in the case of hay fever, is most fre- 
quently found in the nose, though eye-strain, digestive 
and pelvic disturbances may also play their part. The 
commonest disease condition in asthmatics is polypi, 
though any form of disease or deformity of the sep- 
tum or the turbinate bodies, or cavities opening out 
of the nose into the bones of the head and face, known 
as the accessory sinuses, may be found to be present. 
Relief of these conditions by surgical or other means is 
of the greatest importance, and will not infrequently 
stop the attacks entirely for a long period, or make 
them very much milder when they occur. In spite of 
the great relief often afforded by this method of treat- 
ment, it is regrettable but true that the majority of 
asthmatics are only temporarily relieved by treatment 



ASTHMA AND HAY FEVER 165 

of their noses and throats, however thorough and skill- 
ful. Still, every improvement in a disease like this is 
welcome, and the correction of any diseased conditions 
of the nose and throat in asthmatics is abundantly 
well worth while. 

There is a fair prospect that somewhere from twenty 
to thirty per cent may have their attacks stopped en- 
tirely by such treatment, and over half of them will 
receive benefit to the extent of making the attacks less 
frequent or less violent when they do occur. 

Last, but not least, there is the management of the 
patient himself. This cause of the disease, obviously, 
cannot be removed entirely. But it can usually be very 
greatly modified for the better, particularly by such 
means as cold bathing and douching, living and sleep- 
ing in the open air, plenty of moderate but regular 
exercise, and an abundant, carefully-selected dietary 
from which all possible poison foods have been omitted. 
The open-air life and exercise in asthma cases are par- 
ticularly important because they help to reduce or 
oxidize in a normal manner the poisons accumulating 
in the system which are probably the chief cause of the 
explosions. One of the great fathers of modern medi- 
cine, Trousseau, vividly and not inaptly described 
asthma as an "epilepsy of the lung," and certainly the 
same sort of measures which prevent the accumulation 
of " self-made" poisons up to the explosion point prove 
most effective in both these maladies. The judicious 
use of tonics, particularly those which affect the tone 
of the circulation, the heart and the vasomotor system 
generally, is, in skilled hands, often very helpful. The 



166 COMMON DISEASES 

main principle, however, and the most hopeful method 
of attack is to build up, train, and improve the patient 
so that he will forge ahead of and ultimately outlive the 
disease. Obstinate and persistent as asthma is, there is 
one thing tougher and more enduring yet, and that is 
the patient who has it. 






CHAPTER VIII 

FILTER MISCHIEF IN THE BODY: BRIGHT's DISEASE 
AND OTHER KIDNEY TROUBLES 

WE expect too much of our body. We abuse and 
neglect and over-drive it, treat it as if it were 
made of chilled steel and asbestos, and then marvel 
and grumble at it when it breaks down. To paraphrase 
the Psalmist, "Man born of woman is few of years and 
full of kidney troubles." When we say that we are 
fearfully and wonderfully made, it is our fearful liability 
to break down that we are thinking of chiefly. The real 
marvel is that the machine runs as well and as long as 
it does. Every other engine yet invented has to have 
its regular periods of rest for repairs, oiling, and clean- 
ing, but our double cylinder, self-feeding and self-oil- 
ing body-pump, the heart, chugs steadily on day and 
night, "ohne Hast, ohne Ruhe" with the regularity of 
clock-work for three score years and ten. Our best and 
most modern systems of filters have to be built in 
duplicate and triplicate, so that each of the filter-beds 
can be given a period of rest and cleaning and repair- 
ing at least every month. Our most elaborate systems 
of sewage choke and block constantly, and the life of 
the best-constructed of them is less than thirty years, 
even with constant care. Yet we have in the body a 
filtration apparatus which not only purifies to perfec- 
tion every drop of the drinking water of our body- 



168 COMMON DISEASES 

"bugs," but also at the same time discharges the whole 
of our liquid waste from the body, without one mo- 
ment's intermission day or night, cleans itself, flushes 
itself, and increases its capacity as the body increases 
in size, and runs "like velvet" sixty, seventy, eighty 
years. 

Yet, because it is called the kidney and has no wheels 
in it that we can see go round and costs us nothing to 
operate, and the duplicate of it can be bought any- 
where in a butcher's shop for ten cents, and served 
upon our tables in stews, we have anything but a high 
opinion of it. In fact, we are inclined to rather despise 
it as something vulgar and hah way indecent, and 
think that, in the language of the day, we have "a kick 
coming" whenever it breaks down under the strain, 
after thirty-five, forty-five, fifty years' faithful and 
loyal service. 

The kidney is becoming of late almost as notorious 
an organ as the appendix. Like the quack who told a 
gaping patient, when he turned upon him after keep- 
ing him waiting in his consultation room for half an 
hour, "Now, you need n't tell me a word about your 
symptoms! I know all about your case! I've been 
looking at your kidneys through the back of my head 
for the last twenty minutes!" the American people, 
figuratively speaking, has its eye upon its kidney and, 
like the quack, it is looking at it through the back of 
its head, or some other equally opaque and distorting 
medium, The reason for this sudden interest in renal 
troubles is obvious enough. We are beginning to dis- 
cover that we die of them rather oftener than we 



FILTER MISCHIEF IN THE BODY 169 

have fancied. Owl-eyed statisticians solemnly assure 
us that while the death rate from tuberculosis and 
typhoid and diphtheria and the diseases of childhood is 
going down rapidly and encouragingly, that from dis- 
eases of the kidney, of the heart, and of the nervous 
system is going up with almost equal rapidity. 

But there is nothing to become in the least panicky 
about; in fact, the two sets of death rates explain one 
another. What modern sanitation and the progress of 
civilization are doing is to save the lives of children who 
would have died of diphtheria or croup, and of young 
adults who would have been carried off by tuberculo- 
sis, or typhoid, and keep them alive to die of the dis- 
eases of middle and later life — Bright 's disease, heart 
disease, paralysis, etc. We all must die of something ; 
nobody really wants to live forever, although they 
imagine they do, and I see no reason to either expect or 
hope that sanitary science and preventive medicine will 
ever do more than shift the heaviest stroke of the 
death rate from, say under fifteen to over fifty. 

Pessimists may question, "What is the use of saving 
a child from death at six, to have it die of Bright 's 
disease at fifty?" But there is all the difference in the 
world between the two. The man who dies at fifty-five 
or sixty has lived his life, paid back the race for the pain 
of his bearing and the care and cost of his rearing, 
passed on the Torch of Life to the next generation and 
started it well on its way, and the end, whenever it 
may come, has no terrors for him. Death itself is 
nothing, a mere ceasing to live, painless, natural, wel- 
come to nine tenths of all to whom it comes, a rest 



170 COMMON DISEASES 

after life's fitful fever. Our best immortality is the sur- 
vival of what we have done to make the world better 
for our having lived in it. If we have n't done some- 
thing of this sort by fifty, the sooner we die, the better. 

So don't worry about kidney diseases. They, like 
diseases of the heart and of the nervous system and 
brain, are not becoming any more common than they 
were two hundred years ago, except in so far as more 
people are living to be old enough to die of them, and 
we have no real ground for complaint against any dis- 
ease that attacks us after it has let us live fifty years. 

Another reason, of course, for the apparent increase 
of renal troubles is that we have only become able 
to recognize them accurately and correctly within the 
past fifty years. It is only about eighty years since 
Dr. Richard Bright of the famous Guys Hospital, 
London, discovered and traced to its origin the famous 
and fatal disease which now bears his name as Bright 's 
disease all over the civilized world. Even our Ger- 
man confreres speak of it in their pompous Latinity as 
the "Morbus Brightii." 

But as he unfortunately did not discover at the same 
time any cure for the malady, — indeed he is reported, 
though erroneously, to have died of it himself, — the 
memory secured by attaching his name to it is scarcely 
a triumphant, or even a grateful one. Like the police- 
man in the Pirates of Penzance, "the physician's 
lot is not a 'appy one." His occupation is laborious, 
without chance of joining the Union and getting an 
eight-hour day, and though it has its compensations, 
it seldom leads to fame. Almost the only way a doc- 



FILTER MISCHIEF IN THE BODY 171 

tor has of achieving immortality is by getting his 
name attached to some interesting disease, which he 
has discovered, or operation which he has invented; 
and to have one's name eternally associated with dis- 
ease and distress is rather a questionable kind of glory. 
But this kind of fame, or none, is the doctor's alter- 
native. 

What Bright did was to point out that a certain 
type of dropsy, with shortness of breath, headache, 
attacks of convulsions and coma (prolonged uncon- 
sciousness) was caused by a disease of the kidney, sig- 
nalized by albumen in the urine; shown by the fact 
that when the urine is boiled or nitric acid is dropped 
into it, a milky cloud or clot forms in it, from the coag- 
ulated albumen, — thus laying our first foundation for 
understanding diseases of the kidney, so that within 
sixty years we have learned how to prevent most of 
them. And though we cannot always cure them, we 
can so help the body and assist other blood-purifying 
organs like the skin, lungs, and bowels to do substitute 
duty for the damaged kidney, that life can be pro- 
longed for years and even decades. We can't cure 
Bright's disease — yet, but we can keep the patient 
alive and comfortable and in good working condition 
for years and years. 

Bright's disease is simply a badly damaged condi- 
tion of that important blood-filter, the kidney, which 
may have resulted from twenty, yes, a hundred differ- 
ent causes. Like many other discoveries of the causes 
of things, our finding that a badly damaged kidney 
was responsible for Bright's disease simply led us 



172 COMMON DISEASES 

one step further backward in the chain of causation, 
and raised at once the inevitable question, What caused 
the damaged kidney? 

It soon dawned on us that while the kidney was the 
chief sufferer, its disturbances were almost entirely 
due to poisons or infections which were brought to it 
in the blood which it was purifying. In the language of 
the day, it was "more sinned against than sinning." 

In one sense the kidney is rather a simple organ. It 
has a perfectly definite duty, and, like "Captain Reece 
of the Mantelpiece," it does it. 

To put it very briefly, part of our food, the fats and 
starches, are burned clean in the body to gas, or 
smoke, in the form of carbon dioxide and got rid of by 
the lungs and skin. Part of the wastes of our food and 
most of the wastes of our body tissues are given off 
in liquid form, or rather as solids dissolved in water, 
through the kidneys and the bowels. The business of 
the kidneys is picking out this solid waste matter in 
the form of urea and the urates, together with water 
enough to dissolve them and pouring them out of the 
body in the form of urine. 

If these poisonous wastes are not picked out and 
discharged by the kidney, every part of the body soon 
feels the effect. One of the first of the body-stuffs to 
suffer is, naturally, the most sensitive — the nervous sys- 
tem. The patient begins to complain of headaches, not 
severe but dull and persistent and without any apparent 
cause. He begins to be drowsy and listless, and to com- 
plain that while he sleeps heavily his sleep does not rest 
him and he wakes up in the morning unrefreshed. 



FILTER MISCHIEF IN THE BODY 173 

In about one case in ten this poisoning of the delicate 
nerves goes further, and the sensitive retina and then 
the optic nerve become involved. The vision be- 
comes cloudy and poor, and if a pencil of light is 
thrown into the eye with an ophthalmoscope, and the 
inner coat of the eye examined, its clear, bright, 
healthy red is found to be streaked and mottled with 
dull, opaque, white patches. These eye changes sel- 
dom go on to complete blindness, though sometimes 
half or even two thirds of the vision may be lost. This 
dull, persistent headache with dimness of the sight is 
one of the earliest and most significant symptoms of 
the disease. 

Next, and in some cases before the nerve symptoms, 
the cells of the stomach and digestive organs begin 
to suffer from the poisoned blood, and the appetite 
becomes poor, the digestion disturbed, and the bowels 
constipated. This is one of the reasons why errors in 
diet were for a long time regarded as the cause of 
Bright's disease, the real fact being that the dys- 
pepsia and other disturbances of digestion which were 
supposed to cause the disease, were really early symp- 
toms of its existence. 

If nothing be done to check the process and get rid 
of the poison through some other body sewer, such as 
the skin or the bowels, then the deadly drama ad- 
vances, the muscle cells of the heart become involved, 
the heart begins to weaken, the tissues of the body 
become waterlogged, causing the familiar puffing or 
swelling about the ankles and under the eyes and 
shortness of breath from waterlogging of the lungs. 



174 COMMON DISEASES 

At this point Nature will often rally her forces and 
proceed to adjust herself to the situation. Profuse 
perspiration will occur, sweating out some of the poi- 
sons, or a life-saving diarrhoea set in, providing another 
route for their escape, and the patient will pull himself 
together and live in this more or less handicapped 
condition for months and often years. 

Obviously, though able to keep his head above 
water under favorable conditions, he has a narrower 
margin than before. Some day a sudden strain of some 
sort falls upon his hard-set system — a business 
reverse, a death in the family, a period of overwork or, 
much more commonly, an attack of some acute infec- 
tion, such as a pneumonia, a bronchitis, or even a 
severe common cold, and the already weakened and 
dilated heart gives way under the strain and oblivion 
closes the scene. * 

In other cases, the gradual heaping up of poisons in 
the blood goes steadily on until one day the poisoned 
and stifled brain has reached the limit of its endurance. 
The patient suddenly falls unconscious and, after lin- 
gering for a few days, passes away. Many so-called 
strokes of paralysis or attacks of apoplexy are really 
the last act in the drama of Bright's disease. Truly, 
a deadly and until recent years an appalling and 
irresistible scheme of decay! 

Fortunately, this painful picture is already becoming 
a thing of the past. Although we have as yet no means 
of positive cure of the disease, we have so many ways 
of palliating its symptoms and delaying its course — 
methods which, if applied at a sufficiently early stage 



FILTER MISCHIEF IN THE BODY 175 

of the disease, may even check it altogether — that 
the outlook of the patient with Bright's disease to- 
day is good. He may live an efficient and fairly com- 
fortable life for five, ten, or even fifteen years, and 
then die suddenly and painlessly as any one else might 
from pneumonia, bronchitis, heart failure, or apoplectic 
seizure, with a fair prospect that he may secure at any 
time an arrest of the process which will carry him over 
to a good old age. As the disease comparatively seldom 
develops in its persistent, typical form under forty-five 
or fifty years of age, this usually means a fair oppor- 
tunity to round out one's life work and provide for the 
future generation. 

This picture of the disease and its symptoms will 
probably strike many as, in the language of Mr. A. 
Ward, "like the play of Hamlet with the part of 
Othello omitted," for nowhere in the whole catalogue 
is any mention made of that famous and widely ad- 
vertised and unfailing symptom of kidney disease — 
Pain in the Back ! 

Every one who takes his medical knowledge from the 
advertising columns knows that the one symptom 
which infallibly indicates Bright's disease, and which 
"Bog Root Bitters" or "Snorter's Safe Liver and Kid- 
ney Cure" alone can cure, is an agonizing pain in the 
back or stitch in the side. Graphically depicted in the 
familiar masterpieces of the half -dressed gentleman 
with trailing suspenders, clutching madly at the small 
of his back; or the modern Mater Dolorosa, in the pose 
of an early Christian martyr, with one hand over her 
eyes and the other dramatically pressed to her side. 



176 COMMON DISEASES 

The omission was intentional, for the "sure and 
unfailing sign," like the rest of that soul-terrifying list 
of symptoms prefaced by "Have you — ?" and con- 
cluding with, "Then you have Bright's disease and 
only Ballyhoo Bitters can save you," seldom occurs in 
Bright's disease, though it may, occasionally, from the 
same cause as the headache, namely, poisoned nerves. 
In fact, popular impression to the contrary notwith- 
standing, there are few diseases of the kidney — and 
they, for the most part, sudden, acute attacks such as 
occur during the course of a fever or infection — which 
are accompanied by a pain in the back. Nine tenths of 
all attacks of pain in the back are matters of muscles, 
tendons, and nerves, and have nothing whatever to do 
with the kidneys. 

The prime interest, of course, of Bright's disease 
centres upon its cause and the possibility of its removal, 
and upon this head we are able to speak much more 
hopefully than we were fifteen or twenty years ago, as 
our views in regard to it have undergone a very 
decided change. 

When we first became aware that albumen in the 
urine was a sign of Bright's disease, we rather naively 
but not unnaturally were inclined to think that the 
loss of the albumen itself was a matter of importance, 
and to measure the gravity of the disease by the 
amount of albumen in the urine. 

Albumen, it might be said in explanation, is a sticky, 
jellylike substance, like white of egg — which, indeed, 
is pure egg-albumen — present in the blood and in most 
of the tissues of the body, but which does not under 



FILTER MISCHIEF IN THE BODY 177 

ordinary conditions pass through the kidney filter and 
appear in the urine. When it does do so, it is detected 
by the very simple method of adding a few drops of 
strong acid, or boiling, which coagulate or clot it just 
as boiling does the white of the egg y and produce a 
cloudy, or in large amounts, a flaky, almost gruel-like, 
condition of the urine. 

It is a valuable food, and if it were to escape from 
the body in sufficient amounts might cause a serious 
loss of strength by slow starvation. But the first appli- 
cation of accurate measurements relieved our minds of 
this apprehension. For it was shown that even in the 
extremest cases the amount of albumen escaping in 
the urine was so small that the total loss during the 
day would hardly amount to more than two or three 
teaspoonfuls, barely the equivalent of a quarter of an 
egg or a slice of meat an inch square. 

The next idea was that, inasmuch as the substances 
which are picked out by the kidney are almost exclus- 
ively the wastes resulting from the burning in the 
body of proteins or meatlike substances containing 
nitrogen, and rise and fall with the amount of these in 
our food, albumen in the urine was due to overstrain or 
overwork of the kidney from eating excessive amounts 
of proteid foods and particularly meat. As albumen 
is itself a "meat," or animal product, it was supposed 
to be a leaking through of excessive amounts of meat 
which we had eaten. 

This, however, was quickly disproved by the dis- 
covery that the albumen which appeared in the urine 
was not the albumen of our food but the albumen of 



178 COMMON DISEASES 

our own blood and of the cells of our kidneys. In fact, 
it was not the imported meats which were involved in 
the trouble, but the native born, so to speak. Patients 
suffering from Bright's disease could be fed on large 
amounts of egg albumen or milk albumen or meat 
without increasing the amount of albumen in their 
urine in the slightest degree. 

A little further experimenting showed, however, 
that there were two influences which would very 
promptly increase the amount of albumen in the urine 
in Bright's disease, and even produce it in perfectly 
healthy individuals. One was severe muscular work, 
and the other the attack of some acute infectious dis- 
ease or fever. In fact, any influence which markedly 
increased the wear and tear of the cells of the body or 
poisoned them so that they broke down might produce 
albuminuria. 

This led us to examine the urine as a matter of 
routine in all infectious diseases. We found, somewhat 
to our surprise, that from ten to thirty per cent of all 
cases of acute infections, like scarlet fever, diphtheria, 
measles, typhoid, tuberculosis, and even tonsillitis and 
common colds, would show from a cloud to a heavy 
deposit of albumen in the urine, usually during the 
period of convalescence. 

In fact, in all these infections, particularly the dis- 
eases of childhood — scarlet fever, measles, and diph- 
theria — our greatest care and watchfulness is now 
exercised during the period of convalescence, because 
this is the time at which their germs and poisons may 
attack the kidney or the nervous system or the heart. 



FILTER MISCHIEF IN THE BODY 179 

Like the Parthians of classic lore, they are most dan- 
gerous when in retreat, and we are too often roused 
from our happy dream of complete recovery by the 
discovery of an ambuscade in the kidney. Indeed, we 
now recognize that from two thirds to three fourths 
of our cases of Bright's disease are uncured inflamma- 
tions of the kidney following one of the acute infect- 
ious fevers, which have either not been detected at 
the time or allowed to run on and become chronic. 
The best way to prevent Bright's disease is to check 
the spread of infectious diseases. 

Thus the relation between kidney disease and food, 
particularly meat, is now generally regarded as much 
less weighty and important than it was at one time. 
The worst combination and the most fertile cause 
of Bright's disease is getting up and going back to 
work too soon after an attack of contagious disease, 
especially if the work be heavy, the hours long, and the 
food poor. Give Nature plenty of time and rest, and 
she will heal the damaged kidney and restore it to 
perfect working condition nine times out of ten. This, 
in fact, is the stage at which to cure Bright's disease, 
by stopping it before it has become chronic. 

We have begun also to have doubts, from a practical 
point of view, as to the connection between food and 
renal trouble. Since meats produce more urea and thus 
throw more work upon the kidney than starches 
and fats, it is probably a good and judicious thing to 
cut down the amount of them in inflammations of the 
kidneys so as to give the inflamed organs a rest ; yet 
this principle can easily be carried too far. Practically, 



180 COMMON DISEASES 

we find that such patients improve and do well for 
a few weeks, or even a month or two, upon a nearly 
meat-free diet, but after that they lose ground, fail 
in their nutrition, and go down even more rapidly 
than before. 

In fact, it was found, as in most other diseases, that 
the diet which was best for the disease was the one 
which was best for the patient. Our tendency now in 
the treatment of Bright 's disease is to put the patient 
on that diet which will best support and improve his 
nutrition, vigor, and resisting power, regardless of 
whether it be animal or vegetable. In spite of all that 
vegetarians claim, and can prove in a test tube, the 
painful and obstinate practical fact remains that there 
is no real, available substitute for meat which will keep 
up as it will the patient's strength, courage, and fight- 
ing power in a prolonged siege like Bright's disease. 

Moreover, it must be remembered that the kidney 
cells are not picking out urea from the blood solely 
for the protection of the rest of the body, but feeding 
themselves at the same time; so that a diet poor in 
meat may starve and weaken the vigor and resisting 
power of the cells of the kidney just as it does that of 
the rest of the body. 

In fine, the general tendency of expert opinion now 
is, that while it is helpful and advisable to give the dis- 
eased kidney periods of complete rest by cutting meat 
out of the dietary, these "vacations" should be neither 
too long continued nor too frequent, and that the best 
thing to do in a disturbance of health lasting, as 
Bright's disease does, for years and decades, is to feed 



FILTER MISCHIEF IN THE BODY 181 

the patient liberally and judiciously and let the disease 
take care of itself. 

A system of treatment which cures the disease, but 
makes the patient worse, is not of much practical 
value in the long run. "Feed the patient and let 
him fight the disease" is our motto in Bright's disease, 
as in tuberculosis, pneumonia, and a score of other 
maladies. 

The most effective direct treatment now given in 
Bright's disease is in the form of prevention, by recog- 
nizing it in early stages and giving antitoxins, serums, 
or antiseptics which will either kill the germ which has 
caused and perhaps is still keeping up the inflamma- 
tion, or neutralize its toxins and help the system to get 
rid of them. What we try to do in Bright's disease 
now is to search out its cause and, if not too late, 
remove or neutralize this. 

Failing this we summon the bowels and the skin to 
do substitute duty for the damaged kidney, and won- 
derfully, cheerfully, and effectively do they respond. 
Urea will sometimes lie in flakes all over the surface of 
the skin after the drenching sweats of Bright's disease, 
like sea salt in dried-up beach pools. 

The main relation between diet and Bright's disease 
is that unsuitable, unsound, or badly cooked food may 
produce disturbances of digestion, attended by putre- 
faction and fermentations in the food canal whose 
poisonous products get into the blood and are carried 
to the kidney. But these disturbances are now regarded 
as much more frequently due to the poor quality and 
tainted condition of the food than to an excessive 



182 COMMON DISEASES 

amount or an injudicious selection of any kind of 
sound and nutritious food. 

The only remaining stronghold of the dietetic 
causation of Bright's disease is in that fine old bogey 
of pathological nursery tales, Gout, with its evil spirit. 
Uric Acid. To lay this uric-acid ghost completely 
would take more time and holy water than can here be 
afforded. 

But the drift of modern opinion briefly is first, that 
meat does not cause excessive amounts of uric acid; 
and second, that uric acid is not a cause but a symptom 
of gout. And that the same cause, generally a mild or 
chronic infection, which produces the so-called "gouty 
kidney" produces also the uric acid. 

One of the best diets for the gouty is red meats, 
fresh vegetables, and acid fruits. And instead of gout 
being the peculiar penalty of rich foods and high liv- 
ing, the poor have it just as frequently and as se- 
verely as the rich, only they cannot afford to stay at 
home from work on account of a sore toe or a swollen 
finger joint. The rich have more diseases than the poor 
chiefly in the sense that they have more time to lay 
off and enjoy them, and more money to pay doctors 
for listening sympathetically to the recital of their 
symptoms. 

There is another way in which the devoted kidney 
may become diseased besides by the attack of pois- 
ons brought to it in the blood which it is trying to 
purify. The kidney, from the very nature of its work, 
is made up largely of blood vessels — probably two 
thirds of its bulk consisting of a fine network of arte- 



FILTER MISCHIEF IN THE BODY 183 

ries, capillaries, and veins. The walls of the blood vessels 
all over the body are elastic and are under incessant 
strain, both adjusting themselves to the varying 
amounts of blood that are pumped through them and 
also, every second, to the pulse waves driven through 
them by each stroke of the heart pump. 

As is little to be wondered at, after forty or fifty 
years of this sort of thing they are apt to begin to give 
way, and their giving way chiefly takes the form of 
losing their elasticity and becoming stiff, rigid, and 
finally actually brittle. So that one day, under some 
sudden strain, one of them will rupture and let the 
blood in it gush out, and we have what we call an 
internal hemorrhage. If this rupture occurs in one of 
the arteries of the brain we get "an apoplexy," or a 
"stroke of paralysis." 

The blood vessels of the kidney are just as liable to 
undergo these stiffening and crumbling changes as any 
others; and this quickly blocks the filter and causes 
slow blood-poisoning by the accumulation in the blood 
of waste matters which the kidneys cannot get rid 
of. This slow crumbling decay of the arteries (whose 
technical name, arteriosclerosis, often gets into the 
newspapers nowadays) is one of the characteristic 
changes of old age. In fact, so far as we can define or 
localize the general process of bodily decay, it is old 
age. As the old proverb puts it, "A man is as old as his 
arteries." This arteriosclerotic change in the kidneys, 
usually occurring in middle or later life, is one of the 
commonest causes of the slower and more unmanage- 
able forms of Bright's disease. 



184 COMMON DISEASES 

An interesting thing about this chronic arterial 
change is that, while largely due to the prolonged 
general wear and tear of life, it is now known to be 
greatly hastened, and may be brought on prematurely, 
by three great main causes. 

First and commonest of these is overwork, particu- 
larly in the form of prolonged muscular overstrain. 
Men engaged in laborious occupations, such as lum- 
bermen, porters, dock laborers, miners, and day la- 
borers of all sorts, show far the highest percentage of 
this arterial decay at the earliest ages. Twenty years 
ago it was supposed to be the peculiar plague of the 
leisure classes and the sedentary occupations, but this 
was merely due to the fact that these classes alone 
were studied with sufficient care to discover it. Like 
most of the other "diseases of the rich," the poor have 
them just the same and even more frequently, only 
they cannot afford the luxury of diagnosis and treat- 
ment. 

The next great cause of this arterial decay is the 
poisons or toxins of the different infectious diseases. 
In a series of some three thousand patients under fifty 
years of age taken in succession as they entered one 
of our great hospitals and were examined for arterioscle- 
rosis, nearly forty per cent already showed this change. 
The whole number were classified into three great 
groups : those who had worked hard with their muscles, 
those who recently had had one of five or six common 
infectious diseases, — typhoid, tuberculosis, syphilis, et 
cetera, — and those who had used alcohol freely. 

The results were illuminating, for of those who had 



FILTER MISCHIEF IN THE BODY 185 

engaged in hard muscular labor nearly sixty per cent 
showed arteriosclerosis; of those who recently had had 
typhoid or tuberculosis, some forty per cent; of those 
who had had syphilis, some twenty per cent; while of 
those who had used alcohol freely some fifteen per cent 
showed this change. 

From this point of view it would appear that excess- 
ive industry does more to shorten life in the majority 
of men than dissipation; but the group is too small to 
base such radical conclusions Upon. Virtues sometimes 
seem as dangerous as vices, if not indulged in with 
strict moderation. 

To sum up : Bright's disease and other renal disturb- 
ances are probably increasing somewhat. This is only 
because more of us are living to be old enough, so to 
speak, to have earned them. 

The chief causes of them, apart from the necessary 
wear and tear of life, are muscular overwork for long 
hours, the attack of the infectious diseases, and the 
use of alcohol; all of which are perfectly preventable, 
and in fact are being rapidly prevented by industrial 
legislation, by sanitary improvements, and by the 
growth of temperance and self-restraint. In other 
words, civilization is curing, and will continue to cure, 
the diseases which it has helped to cause. 

The damage done to the kidney by the infectious 
diseases usually occurs at a late stage of the illness, 
especially in typhoid fever, diphtheria, scarlet fever, 
and even in common colds. And this attack of the 
kidneys can usually be prevented or, if occurring, held 
within bounds until completely recovered from, simply 



186 COMMON DISEASES 

by keeping the patient in bed and on a milk or other 
simple diet all through the period of convalescence and 
until he has completely recovered from all danger of 
such an attack. 



CHAPTER IX 

THE UNWISDOM OF WORRY 

IT is a matter of official record that care killed a cat, 
And if the habit of excessive introspective reflection 
could work this dire and fatal havoc upon a feline's 
elastic and easy-going temperament and ninefold lease 
of life, what could it not do to a mere one-lived 
"human"? 

As Oscar Wilde cynically remarked: "Nothing sur- 
vives being thought of too much " — not even, alas, 
the thinker! When we begin to carry our troubles to 
bed with us at night, and think about them instead of 
going to sleep, then look out for squalls! We have 
crossed the dead-line between wholesome and neces- 
sary "taking thought for the morrow" and the worry 
that kills. 

A certain amount of thought is healthful, exhilarat- 
ing, and the very secret of success; but there is also a 
form of mental exercise which we dignify by the name 
of thinking, which simply goes round and round in a 
senseless circle, like a squirrel in a cage, or a herd of 
Texas long-horns "milling" in a storm-panic, which 
gets nowhere and simply grinds the nerves of the 
thinker to rags and ribbons. It does no good to any 
one, neither the thinker nor the thought of ; yet we don't 
seem to be able to stop it. In fact, we are often proud 
of our achievements in this sort of self-punishment. 



188 COMMON DISEASES 

This is another danger-signal. Whenever we reach 
a point where we can't let go, where a particular sub- 
ject, like Banquo's ghost, "will not down," or where 
we just can't stop thinking about things, then we 
have lost what the physiologists call our power of 
inhibition. We may be sure that we are beginning to 
do our work to poor advantage, driving our intelli- 
gence with the maximum of friction and the minimum 
of speed, and that a "hot box" or breakdown of some 
sort is looming up ahead of us. So long as we are mas- 
ters of our work, we do it well; when it masters us, we 
do it badly — and it 's pretty sure to do us badly 
sooner or later! 

But there is a reason for everything — even for such 
an unreasonable thing as worry. "As the bird by wan- 
dering and the swallow by flying, so the curse, cause- 
less, shall not come." People do not worry out of sheer 
perversity or ' ' pure cussedness . ' ' There is a cause some- 
where for even this most irrational and wasteful of 
mental habits. Our dispositions, perverse and deceitful 
above all things as we have been taught to regard them, 
are a good deal like horses. They will not jib, or balk, 
or shy, or run away unless they have been ill-treated, 
or frightened, or overworked, or are diseased; though, 
if they have once started the habit, they may keep it 
up without adequate cause. 

If we "humans" would treat our bodies as well and 
as considerately as a farmer does his horses, with regu- 
lar hours for meals, with which no stress of work is 
allowed to interfere; regular sleep, regular grooming, 
and plenty of all three, we should hear little of worry 



THE UNWISDOM OF WORRY 189 

and sleeplessness and neurasthenia, and get just as 
much real work done. 

A few unfortunates there are, both men and horses, 
who are born with "shipwrecky" nervous systems, 
and these furnish the worst illustrations of causeless 
worry, of persistent gloomy forebodings, or, with a 
slightly deeper degree of defect, of shiftlessness, per- 
versity, and even crime. Though I would whisper it 
with bated breath, in New England, worry and over- 
conscientiousness, at one end of the scale, and idle- 
ness and shiftlessness at the other, are usually symp- 
toms of disease or of congenital defect. They should 
be treated with sympathy and medicine, both of mind 
and of body, instead of scolding and reprobation, let 
alone punishment. 

Worry, in fact, is oftener a symptom of trouble than 
a cause. A perfectly healthy human animal, well fed, 
well rested, and worked within his strength, will not 
worry. It is only the disordered liver that "predicts 
damnation." A perfectly healthy man does not know 
he has such a thing as a digestion. A dyspeptic does 
not know that he has anything else. 

Life, as a whole, is composed of at least nine parts of 
happiness and sunshine to one of suffering and gloom. 
The healthy mind sees it in its normal proportions. 
When the ten per cent of discomfort begins to bulk 
larger in our consciousness than the ninety per cent of 
comfort, it is a sign of disease, as well as a fruitful 
cause of more disease. 

Don't scold yourself for worrying unnecessarily, or 
for wanting to cross bridges before you come to them, 



190 COMMON DISEASES 

but look sharply about to find where you are ill-treat- 
ing that faithful, devoted slave of yours, your body. 
You will usually find that you have given him good 
ground for revolt and for causing your imagination to 
play jaundiced tricks with you, by overwork, by under- 
feeding, by lack of sleep, and, not the least frequently 
by lack of play, that literal re-creation, without an 
abundance of which no life can be kept sound and 
sweet. 

We are not quite so sure as we once were of the color 
of sin, but we do know something about the chemistry 
of worry. For it is, at bottom, not simply a bad mental 
habit — though this has much to do with keeping it 
up — nor of sheer perversity, nor even a matter of the 
nervous system, but a question of the chemical com- 
position of the blood; and, indeed, of half the tissues 
of the body. There was a shrewd substratum of truth 
in the ancient quip that whether life is worth living or 
not depends on the liver. The question of whether a 
thing which can be done only once shall be thought of 
but once, or reflected upon in advance sixteen times 
with foreboding, and thirty-two times afterward with 
regret or misgiving, is largely determined by the extent 
to which the liver and lungs have failed to clear the 
blood of its fatigue poisons. 

Fatigue is now known to be produced not by abso- 
lute exhaustion, but by the presence in the blood of 
more or less definite poisonous chemical products of 
the activities of our muscles and nerves. Worry is the 
result of a dilute chronic fatigue. It may even be chem- 
ically defined as the psychic reaction of somatic satur- 



THE UNWISDOM OF WORRY 191 

ation with paralactic acid and monosodic phosphate. 
The important practical bearing of this is that in order 
to restore a fatigued muscle it is not necessary to build 
up anew its exhausted strength — to recharge its bat- 
tery, as it were — but simply to wash its fatigue-poisons 
out of it. 

Let a frog's muscle, for instance, be stimulated to 
the point of apparent exhaustion; then simply flushing 
out its blood-channels with salt and water, through 
its tiny artery, will start it contracting again briskly; 
similarly with the brain that is suffering from nerve- 
fatigue or worry. It is not necessary completely to re- 
build and restore its energy, but simply to flush the 
fatigue-poisons out of it. For this there are two great 
agencies — rest and change of work ! 

Sometimes we are tired out all over, and then the 

only remedy is rest, preferably in the form of 

Tired Nature's sweet restorer, balmy sleep! 
Sleep that knits up the raveled sleeve of care. 

But more commonly our nervous system does not go to 
pieces all at once like the "One-Hoss Shay," but in 
streaks and in sections. Fatigue is generally a local 
issue — like the tariff. 

Often, when we worry, we are not tired at all in the 
greater part of our brain and of our body, but simply 
sick and weary in some distant and insignificant corner 
of our mind, from doing some monotonous little thing 
over and over and over again, until we are ready to 
shriek. Sometimes it is making balances come right; 
sometimes it is writing "your esteemed order received" ; 
sometimes it is planning meals or washing dishes. 



192 COMMON DISEASES 

Whatever it is, it is the deadly monotony of it, and the 
prospect of its going on to all eternity, which is racking 
your nerves to the shrieking point. Whatever it may 
be, stop it ! Stop it, just to show that you can, and to 
discover that the world will still keep on going round 
without it. 

Worry is waste. As a matter of physiological book- 
keeping, it means that instead of simply spending upon 
an action the exact amount of mental energy which is 
necessary to do that action properly, and then forget- 
ting it, you are pouring out from three to five times this 
necessary minimum. Your excessive labor will have 
no useful effect whatever. On the contrary, it is cer- 
tain to produce perplexity and confusion, making you 
do the thing aimed at worse instead of better. As 
Shakespeare puts it in regard to a similar emotion : — 

Cowards die many times before their deaths; 
The valiant never taste of death but once. 

Instead of being prudent and commendable, worry 
is the most extravagant and expensive habit in the 
world. It usually means either that you are trying to 
get twenty horse-power work out of a twelve horse- 
power machine, or that you are rasping, and grinding 
some wretched little weak spot of a bearing or cog into 
a resistance which is throwing the whole machine out 
of gear. The inevitable result is the same in both cases 
— a break-down, either sudden and fatal, which is 
rarest and most merciful, or, more commonly, a 
gradual chronic decay, a growing old before your time. 
Work keeps us alive. Worry ages and kills. 

Every one will admit, even the worrier himself, that 



THE UNWISDOM OF WORRY 193 

it is unwise to worry. The remedy would appear to be 
childishly simple — just stop it! But there's the rub; 
you try, and find that you can't. Like Mr. Atkins, in 
Kipling's ballad, you may be never so firmly convinced 
that "it never did no good to me — but I can't stop it 
if I tried." 

It is practically useless to try to stop worrying by an 
effort of the will — you must remove the cause ! If 
your jaundiced and bile-loaded blood floods your retina, 
making the sky appear green, and the faces of your 
friends a sickly yellow, it is little use assuring yourself 
that the heavens are blue, and the faces of your child- 
ren rosy and fresh. To you they are green and livid, 
and will remain so until the bile is out of your sys- 
tem. 

Of the two great causes of worry, it is hard to say 
which is the more potent. The most pitiful, and the 
most difficult to deal with, is the attempt to get more 
horse-power out of your engine than it was built to 
develop. Many good people cling to the delusion that 
a man can accomplish almost anything that he wills to, 
providing that he wills hard and persistently enough. 
Perhaps he can, in the sense that he is not likely to will 
for the seventieth time unless at least one of the pre- 
vious sixty-nine efforts has yielded him some measure 
of success. The intensity and endurance of a man's 
determination are, roughly, in proportion to the results 
he is getting. 

In the main, it has been proven a thousand times 
that the vast majority of men and women — like en- 
gines, or horses — : have certain limits of achievement, 



194 COMMON DISEASES 

or endurance, beyond which they cannot be pushed, 
except for temporary spurts, without disaster. But 
what we will accept for the mass and the average, we 
flatly decline to apply to ourselves. We are eager to 
believe with Professor James that there may be some- 
where, on some undiscovered peak of Olympus, "higher 
levels of energy," which may be tapped if we strain 
ourselves to the utmost limits of endurance, and then 
a little beyond. If such levels or reservoirs exist, they 
are as yet uncharted, and their existence entirely un- 
suspected by science. 

But leaving this question out of court entirely, the 
important practical fact remains, that, whatever our 
individual possibilities, we are not getting the best out of 
them by overdriving ourselves. 

Purely commercial bodies that handle a large num- 
ber of horses, such as transportation and express com- 
panies, discovered years ago that, just as a matter of 
cold cash, and profit and loss, it pays not merely to 
feed horses well and give them plenty of rest, but to 
work them well under their full strength. In that way 
eight or ten years' service can be got out of a team that 
would otherwise break down and be sold to the peddler 
in five or six years. 

Similarly, manufacturing companies, especially those 
who have regard for a steady product of uniform qual- 
ity, and sustaining a high reputation in the market, 
have found that it pays in actual dividends not merely 
to provide for the proper housing and sanitation of 
their workers, and to pay them good wages, but to 
shorten their hours of work and provide gardens, parks, 



THE UNWISDOM OF WORRY 195 

theatres, play-grounds, and clubs for their proper re- 
creation and healthful amusement. 

Therefore*, if you find that you are overdriving your- 
self, that you are taking your work home with you, that 
you can't get your mind off it, that you begin to doubt 
your ability to get through with it, pull yourself to- 
gether and take stock ! If the work in its entirety is too 
much for you, try to change to some other field of ac- 
tivity better adapted to your powers, or get back to the 
soil. If you're a misfit, a round peg in a square hole, 
don't be too proud to recognize your mistake. A change 
may make all the difference between constant friction 
and ultimate failure, on the one hand, and ever- 
increasing efficiency and success on the other. 

If, as will oftener be the case, you have got into a 
bad or wasteful way of doing your work, think over the 
situation. Get a short vacation, if you can, to change 
the taste in your mouth, no matter where you go; then 
plan your day so as to get plenty of time for your meals 
and digestion afterward, and plenty of sleep. Observe 
your holidays as holidays, as religiously as you do your 
work-days; let nothing interfere with your play and 
your hours in the country. 

In short, plan to put and keep yourself in condition 
to do the largest amount of work of which you are 
capable, in the shortest practicable time. The beauty 
of this method of work is that your capacity, instead of 
diminishing under it, will steadily increase, and your 
task become easier for you instead of harder, not merely 
up to forty years of age, but up to sixty or sixty-five. 

If, on the other hand, as much oftener happens, 



196 COMMON DISEASES 

your worry is a sign not of "all-over" weariness, but 
of local or partial fatigue, then the remedy is easier. 
There was a world of wisdom in Mulvaney's remark to 
the raw recruit: "An' remimber, me son, a soljeron 
the marrch is no betther than his feet." 

The breakdown of a single cog in our body mechan- 
ism, from deadly and relentless overstrain, will throw 
the entire machine out of gear just as completely as a 
broken piston. In most lives it is the deadly monotony, 
the everlasting daily doing of little things, that wears 
and kills, rather than overrush or overstrain. 

We often speak of worry and of insanity as if they 
were modern diseases, utterly forgetful of the fact that 
two thirds of the primitive superstitions and religions 
were pure products of worry and baseless fear; and 
that to-day peasants and day-laborers contribute the 
highest percentage of their numbers to the wards of 
our insane asylums. 

It is really appalling, when we come to consider it 
broadly — the narrowness, the monotony, the everlast- 
ing repetition of average workaday life; the prospect 
of performing the same petty duties day after day, 
month after month, year after year, with nothing to 
end it short of the Great Sleep. Variety is not merely 
the spice of life, but its salt, the very essence of its 
continuance. Intelligent recreation, interests outside 
of the daily grind, changes of scene — these are not 
merely luxuries, they are necessaries of life. 

Not only will no child grow up healthy without play, 
but no grown-up will remain so without it. If one 
section of your powers has become self-poisoned and 



THE UNWISDOM OF WORRY 197 

narcotized from overwork, and another paralyzed from 
utter lack of use, what wonder that you are half dead, 
and begin to worry about the probable demise of the 
other half ! Kill two birds with one stone by giving 
the unused side of you a romp and a chance to keep 
alive, while at the same time you are flushing the 
fatigue-poisons, which make all the handwritings on 
the wall spell disaster, out of the overused side of you. 

I think that few men adequately realize the deadly 
monotony and endless trivial repetition of much of the 
life of their wives and sisters and daughters. They 
themselves have their business interests, their daily 
contact with all sorts and conditions of men, their trips 
to purchase goods and raw material, to visit customers, 
to attend their national and State associations. The 
town or section of the city in which they live has been 
selected as the best or most available place for the 
prosecution of their business, but it may be anything 
but ideal as a place to make a home, or to find con- 
genial society and healthful companionships and sur- 
roundings for their wives and children. 

The average American man is devotedly kind and 
even generous to his wife and family, but he often fails 
to understand how a home, which to him is a delightful 
place to rest and refresh himself for the real struggle of 
life outside, may become a place of deadly monotony 
to be tied up in all day long by an unceasing round of 
duties; the net result and highest achievement of years 
of unceasing work being simply to keep the house- 
hold fed, the clothes mended and clean, and the carpets 
and curtains respectable. 



198 COMMON DISEASES 

Particularly is this the case in families where the 
brood has been reared and the children successfully 
started for themselves in life. The man's business and 
work still occupy and interest him. He is still making 
plans for the future and enjoying the successes of the 
past. His wife, on the other hand, is apt to feel, after 
the strain of motherhood and the responsibilities of the 
training of the family are over, that the keenest of her 
life-interests has, for a time at least, gone out. The 
routine of household existence begins to pall upon her; 
she begins to worry, to brood, to lose her appetite, to 
develop symptoms of illness, real or imaginary. 

She needs a chance to get out of the harness for a 
few months; to see something of the great world out- 
side of her own; to get a fresh grip on life, which will 
enable her to transfer to the world at large the interests 
and the care which have been concentrated upon her 
children. Whenever your wife begins to worry, buy 
the tickets and tell her to pack up for a trip to the great 
city, to the country, to Europe, to the South, to the 
opera season, to some art exhibition or convention — 
any of these is better than a sanatorium, and may save 
months of drugging and dosing at home. 

The best and only cure for worry is to live an active, 
interested, vigorous, cheerful life, with plenty of inter- 
ests outside of your daily work and in other people as 
well as yourself and with full recognition of the gospel 
of play. Keep up your interests, your work, and your 
hobbies, and you will seldom worry, and never realize 
that you're old — until you're one day suddenly dead. 



CHAPTER X 

HEADS AND HAIR: WHY WE GROW BALD 

WE were all more or less bald once and did not 
mind it much, yet the fear that we may be so 
again fills us with panic and haunts us like a night- 
mare. We are sure that the loss of our locks will spoil 
our beauty, in spite of the unanimous testimony of 
those who knew us then that we were much better 
looking than we have ever been since. 

It is really curious how warmly attached we have 
become to our hair. The other earmarks of our 
"second childhood " — the failing sight, the disap- 
pearing teeth, the shriveling muscles — we look for- 
ward to with comparative equanimity, or at least with 
resignation; but the thought of the loss of our hair 
stirs us to wild revolt at once. We may become old 
and feeble, but we will not be a guy! Gray hairs are 
dignified, poetic, even picturesque; but the bald pate, 
which glistens just as beautifully as they do and with a 
warmer, rosier tint, is a thing of horror which is ta- 
boo in art and anathema in literature — save in the 
Sunday supplement. Yet, to the dispassionate eye, 
one is quite as much like a crown of glory as the other. 
The singular feature is that our eyes, our teeth, and 
our thews and sinews are of great utility and most 
vital importance to us, while our hair has been of 
no earthly use, but rather a constant source of care 



200 COMMON DISEASES 

and responsibility. Think of the years that we have 
spent in brushing it, the nerve rack of keeping it "up," 
the incubatorfuls of eggs that have been wasted in 
shampooing it, and the fortunes squandered upon hair- 
revivers, scalp-tonics, and beauty -parlors ! Small won- 
der that the ascetics of every age, priest and puritan 
alike, have agreed upon one thing, that this useless 
and extravagantly expensive nimbus of ours should be 
cut short, or shaved off altogether. 

This brings us to the crux of the entire problem of 
baldness; namely, the human hair having no known 
utility in any degree commensurate with the amount of 
its development, we know neither what to do to "exer- 
cise" it, so to speak, and in that way restore its vigor, 
nor how to modify its conditions so as to promote its 
growth in any special and effective way. Its positive 
diseases the recent progress of medical science has put 
largely under our control, provided the remedies'be ap- 
plied early enough. But we must frankly confess that 
in a considerable percentage of cases the tendency to 
premature loss of the hair is something of which we 
know neither the cause nor the cure. 

The situation is far more encouraging than it was a 
couple of decades ago and may be roughly summed up 
to the effect that one third of all cases of premature 
loss of the hair can be cured, one third can be pre- 
vented from getting any worse, and one third are almost 
unaffected by treatment. This is perhaps somewhat 
reminiscent of the ancient classification of diseases of 
the skin under three heads: those that sulphur will 
cure, those that tar will cure, and those that the devil 



WHY WE GROW BALD 201 

himself cannot cure. But it is the best that can be said 
at present. 

This, however, is significant of the general vagueness 
and inadequacy of our knowledge concerning baldness. 
In fact, we have not even succeeded in agreeing upon a 
definition of it. It is, of course, obviously divisible into 
two great classes — the natural or senile, which comes 
as one of the symptoms of approaching old age, and the 
unnatural or premature. It is but natural that with 
declining years the hair of the head should waste and 
fall away, as do the other tissues of the body, notably 
the teeth and the epithelium of the special senses; but 
authorities are not agreed even as to what might be re- 
garded as the normal time for this loss of hair to take 
place, some placing it as late as sixty years and others 
as early as thirty-five. It is a matter of individual 
peculiarity, like teeth, sight, and hearing; but, roughly 
speaking, the average man has a right to expect to 
keep his "thatch" unimpaired until forty -five, and 
little right to complain of the administration of the uni- 
verse if it begins to "thin out" after fifty. 

We have no figures of any real value showing the 
actual prevalence of baldness in a community either as 
a whole or in different classes and sexes. Statements 
upon these points must be altogether in the nature of 
estimates ; and an estimate is based only upon the ex- 
perience of the estimator. The records of our hospitals, 
even of those especially devoted to diseases of the skin, 
at which one would naturally expect to find many such 
cases, give us no help whatever, inasmuch as a large 
percentage of the bald accept their condition with in- 



202 COMMON DISEASES 

difference or as a matter of course, and would never 
dream of going to a hospital or of consulting a physi- 
cian in reference to it; while the vast majority of those 
who do resent the condition and endeavor to cure it 
turn for relief to the advertisements and the beauty- 
parlors. So that we have absolutely no adequate data 
at hand from which to decide the question, first, 
whether baldness is increasing; and second, whether it 
is more common in the higher ranks of society than in 
the lower, or among brain- workers than among muscle- 
workers. 

As usual, however, in matters where accurate know- 
ledge is lacking, popular conviction is abundant and 
has no doubts whatever about the question. It is one 
of the commonplaces of every-day conversation to hear 
the statements that the hair and the teeth of civilized 
man are going to the dogs together, and that at the 
present rate the race will soon be both bald and tooth- 
less. There are few things more firmly held as articles 
of popular faith than the belief that there is some sort 
of antagonism between hair and brains, that the more 
highly the tissues inside the skull are developed the 
more likely are those upon its exterior to fade and dis- 
appear. I regret to disturb this latter conviction, be- 
cause it is one of the chief consolations of the bald- 
headed. "There are two things, sir, that you never 
saw — a red-headed nigger and a baldheaded fool!" 
Or as a friend of mine, whose head had come through 
his hair at an indecorously early age, explained it, 
" 'T is the burning brain beneath." There is, however, 
no valid and adequate evidence for this belief, and 



WHY WE GROW BALD 203 

there are several straws which appear to point in the 
opposite direction. 

In the first place, while it seems probable, both upon 
a priori grounds and from such evidence as we possess, 
that baldness is somewhat less common among savages 
who still regard long hair as an adornment in both 
sexes, and whose scalps are continuously exposed to 
the elements, the hair thus actually being of some func- 
tional use as a protection for the head, there can 
nevertheless be no question that from a very early 
stage of civilization, certainly from the dawn of litera- 
ture, the term "baldhead" has been in common use 
as an expression of scorn and derision. Moreover, the 
condition is referred to in the earliest proverbs of many 
literatures and races, always as an undesirable, but by 
no means unusual, consummation. 

Then, too, wigs have been in common use all over 
the world from a very early stage of civilization. Much 
of their vogue must probably be ascribed to ideas of 
ornamentation and ceremonial, the effect produced by 
them being considered more becoming and more digni- 
fied than that of the natural hair, as was still the case 
within the memory of our own grandparents. Yet the 
"digs'* that have been made at them and at their 
wearers from a very early period (the joke, for in- 
stance, of the elderly beau with the curly, raven locks, 
whose wig is dragged from his head by the fish-hook of 
the irrepressible younger brother, is at least as old as 
Nebuchadnezzar) clearly indicate that, while originally 
used as additional decorations, they quickly became 
adapted to concealing defects beneath; while fringes, 



204 COMMON DISEASES 

switches, bangs, false fronts, and "rats" have formed 
a part of the toilet accessories of the gentler sex from 
the days of the Pyramids. 

The other belief, that baldness is more common 
among brain-workers and in the upper or educated 
classes than in the lower, is equally devoid of substan- 
tial basis. Of course the records of any specialist in the 
diseases of the scalp would show that a vast majority 
of those who consulted him on the condition of their 
hair were of the wealthier, and hence more highly edu- 
cated, classes; but this is because these classes take 
this condition most seriously and have money to spend 
on attempts at its cure. Similarly this same specialist 
will state that he has a larger percentage of cases of 
baldness among his private patients than he has in his 
hospital clinics ; but for the same reason this fact means 
nothing whatever as to the comparative frequency of 
the condition in these two social strata. Any one, how- 
ever, can assure himself by a few days' observation 
that baldness quite frequently occurs at an abnor- 
mally early age among farmers, day-laborers, sail- 
ors, fishermen, and workingmen of all descriptions; 
though perhaps it is a trifle more common among those 
of sedentary occupations and among brain- workers. 

At all events we may console ourselves, with the 
belief that there is no adequate basis for our fears that 
the hair of civilized man is doomed, or that baldness is 
increasing in any very marked degree, or that the con- 
ditions of civilization are unfavorable to the health and 
vigor of the hair. 

One of the things that first led us to doubt the reality 



WHY WE GROW BALD *205 

of this alleged increase of baldness was the utter worth- 
lessness and inadequacy of most of the explanations 
which were advanced to account for it. The common 
impression which associates our thinning locks with the 
wearing of unventilated and tight-fitting hats, for in- 
stance, was exploded long ago. The class of men who 
wear their hats most continuously are the outdoor 
laborers — farmers, fishermen, etc. — among whom 
baldness certainly is no more common than among 
indoor workers and city-dwellers. Ascribing it to the 
pressure of the brim of the hard hat, whether derby or 
chimney-pot, upon the temporal arteries is little better 
than fiction, inasmuch as these arteries do not supply 
the region of the scalp in which baldness first appears. 
The alleged lack of ventilation from tight and almost 
water-proof materials is equally absurd, because the 
average city-dwelling male wears a hat for only two or 
three hours out of the twenty -four; and in its power of 
cutting off air and light and producing a sodden, ill- 
ventilated condition of the scalp a hat is not for a mo- 
ment to be compared with the coiled mass of hair (to 
say nothing of the artificial additions thereto) worn 
for at least fourteen or sixteen hours out of the twenty- 
four by the gentler sex. 

Finally, while the head-gear of the civilized male is 
far from rationalized, yet for unwholesomeness and 
uncleanliness it is not to be compared with the horrible 
coiffures, bonnets, turbans, etc., worn by savage or 
semi-civilized men. As a matter of fact, never in the 
history of the race has the human scalp been kept in a 
cleaner, more wholesome, and more healthful condi- 



20C COMMON DISEASES 

tion than it is on the male head of the twentieth cen- 
tury. So, instead of dreading a further deterioration of 
the hair, we should upon a priori grounds expect a 
steady and continuous improvement in its health and 
vigor. 

Although there is still a plentiful lack of positive in- 
formation upon the point, it is the opinion of most of 
those who are in a position to know that baldness is 
distinctly less common among women than among 
men. Why this should be so is one of the mysteries 
that enshroud the gentler sex. If the extreme length of 
the hair and its consequent distance from the centre of 
nutrition, the alleged drag upon the roots, and the 
prevention of proper ventilation and the cooling of the 
scalp count for anything, we should certainly expect 
absence or failure of the hair to be far more common 
among women than among men. While it becomes 
any mere man to speak with the utmost caution and 
diffidence upon such a mysterious and deceptive sub- 
ject, yet we will probably be safe in stating that at 
least three times as many men as women become bald, 
both prematurely and naturally. Scientific derma- 
tologists are practically agreed that, while a great 
many women consult them for real or imaginary 
thinning and loss of the hair, this thinning is far less 
common than among men, and that positive, abso- 
lute baldness of the billiard-ball type is decidedly rare 
among them. Curiously enough, there is also a differ- 
ence between the sexes as to the region in which this 
thinning and falling of the hair begins and chiefly 
occurs, in man this being almost invariably the vertex 



WHY WE GROW BALD 207 

where the natural whorl shows itself in the hair, or 
some portion of the crown of the head. In women it is 
the temples and hair-line above the forehead. These 
regions are supplied by different arteries, but this gives 
us no light on the problem, as there is no known or con- 
ceivable reason why the temporal arteries should first 
fail to nourish their region of the scalp in the female 
and the occipital and the frontal arteries in the male. 
The only explanation which has been offered is a 
somewhat curious and, at first sight, rather far- 
fetched one, and yet one which on biological grounds 
has considerable weight. This is based upon the uni- 
versally recognized anthropological fact that the chief 
function of the human hair is not utility, but ornament- 
ation. It belongs to the great group of what are known 
as the ornamental, or secondary sexual characters, 
such as the plumes and coloring of birds, the mane of 
the lion, the antlers of stags, etc. While it has a cer- 
tain small degree of utility as a protection for the 
crown of the head, it is perfectly obvious that this 
function would have been just as effectually served by 
a short, thick, mossy growth, not to exceed an inch or 
two in length. Moreover, in the process of develop- 
ment in length and consequent capacity for orna- 
mentation, it has, so to speak, deliberately got rid of 
the element most important for the purpose of pro- 
tection against either wet or cold, that is the so- 
called under-fur, or pelage, which is present in the 
coat of almost every other hair-covered animal, reach- 
ing the highest degree of development in such fur- 
bearers as the mink and the seal. Traces of this under- 



208 COMMON DISEASES 

coat or true fur appear upon the human scalp at 
an early stage of its development, but are lost com- 
pletely in the course of the development of the im- 
mensely elongated permanent hair. It might also be 
noted incidentally that the hair of the human head is 
practically an entirely new development, like nothing 
else in the animal kingdom, so that its pedigree is a 
short one, and this may account in some degree for its 
marked instability. 

That hair was regarded chiefly as an ornament by 
primitive races needs no argument from any one who 
has the slightest familiarity with the manners and cus- 
toms of any tribe of savages. Our Indian braves, for 
instance, spend no end of time in braiding and greasing 
their long black hair, and in decorating it with feathers, 
wampum, coins, and primitive jewelry of all sorts. 
Even such a highly civilized race as the Greeks, it will 
be remembered, combed and braided their long hair as 
a solemn, ceremonial preparation for battle. Indeed, it 
is not in the least necessary to go back to savagery for 
proof of the fact that our hair is regarded chiefly in the 
light of an ornament, for ninety-nine hundredths of the 
harm done by the most complete denudation of our 
scalps is the injury to our vanity and self-love. It is the 
abject fear of what we will look like and how the small 
boy upon the street will jeer at us, when we are bald 
and shiny, that spurs us to spend millions upon hair- 
tonics. 

Here, however, a marked difference between the 
sexes comes in. While among savages and races in the 
earlier stages of civilization, as late indeed as the love- 



WHY WE GROW BALD 209 

locks of the Cavaliers, man as well as woman prized 
and cultivated long tresses as a mark of beauty and of 
dignity, for many generations now the majority of the 
sterner sex have thrown away such vanities and re- 
duced themselves to a more or less "crop head" con- 
dition — not, of course, because we think hair is more 
becoming when worn a la blacking-brush, but simply 
that we have abandoned in disgust all hope of com- 
peting with the gentler sex in the matter of beauty. 
Why we should have so tamely surrendered our birth- 
right is one of the mysteries of the universe, for by 
all the rules of precedent and history we were entitled 
to regard ourselves as the ornamental sex, as indeed 
is still the case almost everywhere throughout the 
animal kingdom. 

However this may be, the upshot of the matter is 
that, we having for so many years scorned our birth- 
right, and human hair having become entirely orna- 
mental and practically useless since the invention of 
hats and caps, our wise and parsimonious Mother 
Nature, with the rigid economy which distinguishes 
her, has turned to other and more profitable uses the 
energy which she formerly devoted to growing the 
male hair long and keeping it on, and we lift up our 
voices in dismay when we find ourselves bald before 
our time. While woman, who has never for a moment 
abandoned her claim to a wealth of hair as her princi- 
pal crown of glory, has experienced the truth of the 
Scriptural prediction that unto her that hath shall be 
given. 

Practically, from a biological point of view, there is 



210 COMMON DISEASES 

this great difference between the sexes : While baldness 
in a man is no especial addition to his beauty or at- 
tractiveness, it in no way interferes with his success in 
life, including the most important part of it from a 
racial point of view, the finding of an attractive and 
desirable mate. On the other hand, the woman who 
in the spring or summer of life should become bald 
would have the greatest possible difficulty in finding a 
mate, or in keeping him afterward if she should secure 
him under false pretenses. So that, racially speaking, 
any hereditary tendency to premature baldness in 
women would be apt to die out with great swiftness. 

It might almost be said that there is practically no 
real danger of more than one woman in a thousand 
losing a larger percentage of her hair than can be com- 
pletely concealed by the kindly assistance of art; while 
on ninety-nine men out of a hundred who endeavor to 
rethatch themselves and assume a juvenility if they 
have it not, a wig is unmistakably a wig, even at forty 
rods. 

But what consolation is there in this for the bald and 

the near-bald? They are concerned 

About de ha'r dat is n't dar 
An' why de ha'r am missin', 

as the darkies sing about the possum's tail. Even if 
it be an evolutionary tendency, they want it stopped, 
if such a thing be possible. The outlook is not nearly 
so hopeless as might be supposed, although of course 
it is obvious that in a condition of whose causation we 
have so little accurate knowledge we cannot say much 
that is positive or definite in regard to its cure. More- 






WHY WE GROW BALD 211 

over, each individual case of baldness will depend very 
largely upon personal, individual factors, such as 
heredity, life habits, and general nutrition, and these 
can be elucidated and dealt with only through a thor- 
ough and careful examination and study by a compe- 
tent expert. Broadly and loosely, however, it may be 
stated that while a certain natural tendency, often 
hereditary, is at work in a large percentage of all cases 
of baldness, whether actually premature or merely 
excessive for the years attained, this tendency is often 
markedly aggravated by certain individual or acci- 
dental conditions, the removal of which will markedly 
check or even arrest the process altogether. Nature 
has not the slightest sense of fair play, or the faintest 
scruple against hitting a man or a tissue, when he or it is 
down. Indeed, if there be any organ or region of the 
body whose vitality is lowered in any way, or which 
shows any tendency to decline, this is precisely the one 
that will suffer most heavily in any disturbance of the 
general health. Moreover, those tissues and structures, 
such as the hair, the nails, the teeth, and the skin, 
which are farthest from the centre of circulation are, so 
to speak, like the outposts of an army, very likely to 
have their supplies cut off or their communications 
interrupted. This is one of the reasons for the familiar 
fact that the hair, even in those who show no special 
tendency to baldness, will fall out more rapidly than 
normal, lose its lustre, and become thin and sparse in 
many different disturbances of the general health. In 
fevers, of course, it may be lost completely, but this 
form of baldness, fortunately, is almost never perma- 



212 COMMON DISEASES 

nent. The hair almost invariably grows in again and 
may even be improved by the accidental shedding, 
although in some cases its quality and thickness are 
permanently impaired. So that our dermatological ex- 
perts find not a few cases of falling hair, particularly in 
women, which can be completely checked by correcting 
errors primarily of the digestion and secondarily of the 
liver and kidneys. 

In another considerable class the chief aggravation 
of the tendency comes from the invasion of the weak- 
ened scalp and dwindling hair-follicles by some form of 
bacillus or bacterium. Contrary to popular impress- 
ion, however, these germs are comparatively seldom 
the primary or chief cause of baldness. The healthy 
hair has a surprising degree of resistance to bacterial 
and parasitic invasion. Indeed, in young life, it is sel- 
dom that even the most furious attacks of parasitic 
organisms produce more than temporary baldness. 
Some of these are both distressing and disgusting in 
their effects, and may even affect the general health 
through the suppurative processes which they set up 
in the scalp, yet they comparatively seldom produce 
even temporary loss of hair. The nearest approach to 
this is that produced by the familiar ringworm {Tinea) 
of early life. So that, while in a certain percentage of 
cases the progress of the condition can be checked by 
the application of appropriate remedies to destroy the 
microbial organisms present, the indiscriminate applica- 
tion of strong antiseptics and germicides to the scalp is 
not only useless, but may easily do more harm than good, 
as most of these are highly irritating to living tissues. 



WHY WE GROW BALD 213 

In short, the main hope of stopping the advance of 
baldness lies in the direction of improving the general 
health and vigor, while at the same time keeping the 
scalp and the hair in a clean, antiseptic, well- ventilated 
condition. Unfortunately, however, the rewards of 
virtue are no more certain in this realm than in any 
other. Many a man who keeps his scalp as clean as a 
fresh-laundered table-cloth, and his bodily health in 
perfect condition, will still find himself the victim of 
an aggressive and progressive baldness. Indeed, the 
actual condition of the scalp and of the hair has very 
much less to do with the health of the latter than is 
popularly supposed. The bulbs of the roots of the hair 
go down completely through the skin and into the 
fatty layer which lies between it and the skull, and the 
thing that to the expert eye is really significant of the 
prospect as to progress or cure in a particular case is 
not the condition, or color, or cleanliness of the scalp, 
but the thickness or thinness of this fatty layer which 
underlies it. So long as this is present and the scalp is 
freely movable over the skull, there is hope of restoring 
a reasonable growth of hair; but when this fat has been 
absorbed and the shiny scalp sticks as closely to the 
skull as the cover on a baseball, the outlook is practi- 
cally hopeless. This, of course, shows at once the 
futility of most of the local applications to and mani- 
pulations of the scalp, from which it suffers untold tor- 
ments in those who are or imagine themselves to be 
becoming bald. 

Most of the remedies which are so confidently be- 
lieved in and applied to the scalp have about as much 



214 COMMON DISEASES 

effect upon the vigor of the hair as they would have 
if rubbed upon the soles of the feet. No known local 
applications or manipulations are capable of increas- 
ing the thickness of the underlying fatty layer when 
once this has begun to melt away, though skilled and 
regular massaging may help to delay its wasting. The 
strongest and most powerful curative element of scalp- 
tonics and hair-restorers is their smell, and the next 
most powerful their color. Most of them are frauds, 
pure and simple, and produce no effect whatever ex- 
cept upon the imaginations and the nostrils of their 
users. The most common constituent of them all is 
alcohol, and the next common probably ammonia or 
some aromatic oil or extract which has the double ad- 
vantage of a powerful odor and of producing a mild 
sense of warmth and local irritation. All of this class 
are mild irritants to the skin and produce a slight 
temporary increase in the amount of blood circulating 
through the scalp; but this has about as much effect 
on the hair-bulbs as the beams of the harvest-moon 
have upon growing cabbages. Such slight practical 
utility as they may have depends upon the vigor with 
which they are rubbed into the scalp and upon the 
extent to which they promote cleanliness by virtue 
of their power of dissolving fats or other substances 
which may clog the hair. This last effect, however, 
may be very easily overdone, inasmuch as the scalp, 
like the rest of the skin, to be perfectly healthy needs 
to be slightly oily or even greasy. If it becomes dry 
and harsh it is much more likely to become diseased. 
It is hardly necessary to assure any one of average 



WHY WE GROW BALD 215 

intelligence or sense of humor that the outrageous 
pretensions made by hair- tonics to "grow" hair five 
or six feet long are the purest of fairy tales. Any 
girl or woman who happens to have an unusually lux- 
uriant growth of hair can make a comfortable income 
by allowing herself to be photographed as an example 
of "after using," or more effectively yet by sitting in 
some shop-window and exhibiting herself as a living 
example of the virtues of Humbugine. 

It may, of course, be attributable only to the stupid- 
ity and ignorance of the medical profession, but cer- 
tain it is that we know absolutely no remedy of any 
sort or description that has been proven to have the 
slightest direct effect in either increasing or checking 
the growth of the hair. The best cure, of course, is 
prevention. While we must frankly state that, for 
reasons already explained, it is by no means certain 
that prevention will always prevent, in a general way 
it is safe to say that those who keep themselves in good 
general health by sensible diet, plenty of fresh air, and 
plenty of exercise, and who keep the hair clean, well 
brushed, and well ventilated, will have done all they 
can toward the prevention of baldness and will be 
decidedly less likely to suffer from it than if they 
neglected themselves. On the other hand, it must be 
ruefully admitted that many a dirty savage, whose 
rule of diet is to eat all he can as often as he can get it, 
and to starve as stoically as possible when he cannot, 
who never takes any exercise between meals if he can 
help it, who sleeps in the vilest and most cave-like of 
huts, and who continually rubs grease, ochre, and 



216 COMMON DISEASES 

sticky pigments of all sorts into his hair and even fills 
it full of dust and wood-ashes to relieve the irritation 
of the parasites with which it swarms, has a perfectly 
magnificent head of the glossiest and longest hair, 
which he never loses until it is lifted by the scalp - 
knife of his enemy. So don't fuss with the scalp any 
more than is reasonable. 

The rules of health for the hair, so far as we know 
them, are few and brief. Brush the hair thoroughly at 
least once a day, but let the scalp alone. Let the 
brushing be thorough and preferably with two brushes, 
which you may use as if you were currying a race-horse 
to get him into show condition. Keep the hair thor- 
oughly clean in this way, and the scalp will largely take 
care of itself. Wash the hair as often as may be needed 
for cleanliness, which, as a rule, for men will be once a 
week, and for women about half as often. Avoid using 
too strong soaps, strong alkalies, such as ammonia and 
soda, and too hot water, as all of these take out too 
much of the natural lubricant, or oil, of the hair and 
leave it dry and harsh. As a rule, it is well to dry-clean 
the scalp as much as possible; and it is surprising how 
clean the hair and scalp can be kept just by thorough 
and regular brushing and currying alone. The most 
important detail about the washing of the hair is that 
it should be rubbed or brushed until thoroughly dry. 
If this be done, in the short hair of men there is no 
objection to wetting it daily or even two or three times 
a day if desired. The risk in leaving it not perfectly dry 
is that the natural oil of the hair, when mixed with 
water, rapidly decomposes or ferments, with the pro- 



WHY WE GROW BALD 217 

duction of the all too familiar and none too pleasant 
sour or half rancid smell of badly kept hair. This con- 
dition both irritates the scalp and furnishes a fine 
culture-medium for germs which thereupon promptly 
sweep in and give rise to the commonest form of dand- 
ruff or scaliness of the head. Particularly objectionable 
is the habit of wetting or "slicking" the hair in order 
to comb it, and avoiding the use of the brush alto- 
gether. The intelligently used brush is the best known 
hair-tonic. But when the vigor of the hair is beginning 
to fail, even this may be carried to an extreme and 
become injurious. 

While it is well to keep the scalp dry and well ven- 
tilated and exposed to both light and air, there does 
not appear to be any valid ground for the belief that 
going bareheaded, particularly in the sun, in any real 
way promotes the vigor of the hair. Indeed, so far as 
we know anything about the intentions of Nature, the 
human head was never intended to be exposed to the 
direct rays of the sun at all. As a shrewd old Hindu 
proverb puts it, "Only fools and Englishmen walk in 
the sun." And experts are unanimous in declaring that 
an excessive exposure of the already thinning hair to the 
direct rays of the sun will not only not check the pro- 
cess but often accelerates it. I have seen a good many 
bald heads exposed to the no-hat cure on both coasts 
of this continent, but I never yet have seen any crop 
produced thereon that was visible to the naked eye, 
except blisters. Like the shoe, the hat, while a good 
deal of a nuisance in many ways and a frequent source 
of inconvenience, discomfort, and absurd extrava- 



218 COMMON DISEASES 

gance, is probably more helpful than harmful, not 
merely to the head, but to the hair. It should, of 
course, be kept within reasonable limits and made as 
soft, light, and porous as possible, but there does not 
appear to be any good reason for blaming the alleged 
decadence of our hair upon our headgear, however 
irrational and even absurd this may be at times. 



CHAPTER XI 



HEART DISEASE 



THE human body is not like the "wonderful one- 
hoss shay." It practically never goes 

"To pieces all at once, — 
All at once, and nothing first, — 
Just as bubbles do when they burst." 

Our great vital organs are not within thousands of 
years of the same age, so why should they be expected 
to die all at the same time? Our lordly Ego is not a 
person, but a parliament, not a monarch, scarcely even 
a republic, but a loose confederacy of equal and inde- 
pendent states. Its disruption and final dissolution is 
very rarely due to general decline and decay, but to a 
sudden secession, or even rebellion, of one of the 
Original States of the Union, the heart, the brain, the 
lung, stomach, or kidneys. The other great body state, 
the State of Mind, though it makes more noise than 
all the rest of them put together, is but a Territorial 
Representative in the Congress, with the right to talk, 
but no vote. In the language of Dr. Holmes's shrewd 
old philosopher deacon, 

" 'T 's mighty plain 
Thut the weakes' place mus' stan' the strain ; 
'N' the way t' fix it, uz I maintain, 

Is only jest 
T" make that place uz strong uz the rest." 



220 COMMON DISEASES 

It is usually the weakest or most tried State in the 
Body Confederacy which "lies down," or revolts, and 
the business of the thoughtful physician is precisely to 
"make that place uz strong uz the rest" — if he can. 
In the Game of Life, hearts are always trumps, and 
when the ace is played everything else falls. When the 
heart stops we stop. Not because our emotions can no 
longer throb and our passions burn but because — our 
pump is broken! Never, however, does it die save in 
the last ditch and usually by the treachery of some 
other organ, or after all others have deserted it. Our 
consciousness may have fled, our senses failed one after 
the other, our stomach ceased to digest, our kidneys 
and liver to secrete, our lungs even to breathe, but our 
loyal heart throbs doggedly on, until either the cow- 
ards come sneaking back one after the other, to chase 
the retreating enemy, or it can struggle alone no longer 
and breaks. Then, and not till then, we die. Techni- 
cally speaking, all deaths are deaths by heart-failure, 
because it is the last great organ to stop. 

Yet we sometimes blame it for not standing the strain 
of civilization, because more and more deaths are being 
attributed to it in the health reports ! What is really 
happening is that it, with sanitary and medical assist- 
ance, is carrying a larger and larger percentage of us 
through the food-poisonings of infancy, the infections 
of childhood, and the tuberculosis of adolescence, to 
die later, as we all must somehow, of the scars it has 
received in its battles in our defense. Whatever else we 
may deplore about ourselves we may be sure that our 
hearts are in the right place and doing their duty nobly. 



HEART DISEASE 221 

The first thing to be clearly grasped in considering 
diseases of the heart, as of any other single organ, is 
that they are seldom the fault of that organ in particu- 
lar. Indeed, they are much more frequently its mis- 
fortune, and due of tener to strains thrown upon it by 
other organs and systems in the body, than to its own 
inherent weakness. 

In the majority of cases of heart disease, for in- 
stance, the lining, or the muscle, of the heart has 
simply become infected by the infected, or poisoned 
blood, which is being pumped by it all over the body. 
The heart of course is nothing more than a thick- 
walled, four-chambered bulb syringe which has grown 
up in the centre of that curious, closed pipe-line system 
of the body, which we call the circulation. The only 
point in which it differs from a bulb syringe is that 
instead of needing to be squeezed, or compressed by a 
hand from without, it squeezes itself and shoots out 
its charge of blood automatically, by the shortening 
of the muscle fibres in its own wall. It is a self- 
squeezing sponge with four large pores and valve flaps 
at each end of it to keep its contents from squirting 
backward, while allowing them to spurt forward. 

Indeed the first heart in our own bodies was nothing 
but a pulsating muscle sponge, with its pores filled with 
blood, as it is yet in our distinguished antediluvian 
relatives, the clam and the oyster. It can grow up any- 
where in the body, in fact in four or five places at once, 
and originally was not a single organ. Worms and 
leeches, for instance, have six to eight hearts; frogs 
five, horses and whales and bats have pulsating knots 



222 COMMON DISEASES 

of blood vessels in various parts of their bodies — sup- 
plementary hearts as it were, and we ourselves have 
the remains of pulsating sponges of this sort in our 
spleens, our kidneys, and our receptaculum chyli. 

It had a single bulb to begin with, then it grew, for 
obvious mechanical reasons, into two, as it still re- 
mains in fishes, a third "bay-window" is built on, for 
the use of the lungs in frogs and reptiles; and finally 
a fourth in birds and mammals, including of course 
"humans." Whether it will ever become six-cylindered 
remains to be seen. 

There is nothing in the heart which cannot be found 
in the smallest artery or vein. A wall, or coat of muscle 
fibres, which, by their shortening, pump on the blood; 
a lining of smooth, flat cells to prevent friction, are 
found in every blood vessel in the body. Every one of 
these tiny muscle fibres and rings plays its part in 
driving on the blood, and our heart is literally as big as 
our body and goes all over it. 

The most effective way to remedy heart-mischief 
is to treat the entire body, and let the heart alone as long 
as possible. Play your long suit and save your trumps 
till you need them! 

The only things that are new or original about the 
heart are the valves. These are little ridges, or folds, 
of both the muscular and the lining-coat of the bulb- 
syringe, which project ring-fashion into its inlet and 
outlet. Originally, when pulsations were slow and slug- 
gish, they contained muscle as well as lining, as some 
of them do still in snakes, birds, and even some low 
mammals, and were thick and juicy enough to be as 



HEART DISEASE 223 

alive and vigorous as any other part of the heart. But 
as the stroke of the heart pump became more rapid and 
its delivery more accurate and precise, these ridges 
and folds gradually became flatter, thinner, and more 
fibrous, until now in our own hearts they have become 
changed into thin, tough, parchment-like flaps of about 
the thickness of note paper and of a corresponding 
fibrousness and "half-deadness." They have thus be- 
come veritably "points of least resistance " in the 
heart, both on account of these changes and because 
they are subject to incessant movement and strain, 
snapping backward and forward, resisting the full 
power of the heart muscle, eighty times a minute day 
and night, so long as life endures. It is little wonder 
then that any invading germ, which gets into the body, 
and reaching the blood, is pumped through the heart, 
should manage to lodge in the little pockets, or angles, 
at the base of the valves, and find a foothold upon 
their leathery and half- vitalized fibres, producing what 
we term valvular or organic heart disease, or for short, 
heart disease proper. 

Even an infection, which is virulent enough to attack 
the whole lining of the heart, setting up what is known 
as endocarditis — " within-the-heart inflammation" — 
(the unpleasantly familiar term " His " means simply 
"inflammation," wherever found) appears to fall 
heaviest upon the attenuated tissues of the valves, half 
cut off as they are from their blood supply, and we 
get inflammation deepening to ulceration, eating away 
portions of the valve. Or if healing is secured before 
this, the scars that form in the process may twist and 



224 COMMON DISEASES 

distort the flaps, so as to render them quite incapable 
of closing the pump opening. In fact, the heart pump 
is mechanically damaged just as an ordinary kitchen 
or barnyard pump would be by cutting its valves, or 
by scalding, or drying them until they warp or shrivel. 

As will readily be gathered, the most frequent cause 
of permanent heart disease is, not any defect or pecu- 
liarity in the heart itself, but simply its infection and 
attack by germs and poisons floating in the blood. 
Everybody, in fact, knows that rheumatism may "set- 
tle in the heart" and the veriest tyro in medicine will 
promptly inquire for a history of rheumatism, or rheu- 
matic fever, whenever his stethoscope tells him that he 
has to deal with a case of valvular heart disease. 
But it is not so generally known, and indeed was not 
recognized in scientific circles until comparatively re- 
cently, that not merely rheumatism, but any acute 
infectious disease, or fever, may in the course of its 
invasion of the body, attack and cripple the heart. 
The rather loose and probably varied group of germ 
infections which we term rheumatism, still comes first 
in the list of heart-breakers, but it is closely followed by 
a number of others, particularly diphtheria, pneumonia, 
blood-poisoning or pus-fever, scarlet fever, typhoid, 
measles and whooping cough, even summer dysentery 
or diarrhea, and last, but by no means least on account 
of their enormous frequency, sore throats and "com- 
mon colds." 

In fact there is scarcely an infectious disease which, 
if it lasts long enough, may not attack the lining of the 
heart and leave a damaged valve as a legacy. This is 



HEART DISEASE 225 

one of the most interesting new side-lights upon our 
campaign against the infectious diseases, for we are 
coming to be more and more strongly impressed with 
the fact that the damage which they do is not to be 
reckoned merely in the deaths which they cause — in 
fact this may be a minor part of their deadly influence 
upon the race — but also must include the scars and 
maimings which they leave in those who have survived 
their attack; scars in heart and kidney, in lungs and 
in nervous system, which their survivors will carry to 
their graves and which may even hurry them to this 
goal. 

At all events, the first thing that the physician does 
when he is confronted with a case of heart disease, is to 
" chercher lafemme" (" look for the woman in the case ") 
in the shape of some infection or fever, even though it 
be but a summer diarrhea or a common cold. This is 
not merely of rational, but also of practical importance, 
from the fact that if the case is discovered within a few 
weeks or even a few months of the causal infection, we 
can endeavor to neutralize the action of its germ or 
toxin by an antitoxin, if we possess one, as fortunately 
we already do in the case of diphtheria, blood poisoning, 
and certain forms of rheumatism, or failing this, by 
such remedies as will promote the throwing off of the 
poison and the sterilization of the blood. If the condi- 
tion is of too long standing for this, and the damage is 
already done and over with, still our knowledge of the 
germ causation of the trouble is of some practical value 
because it enables us to control and to some extent pre- 
vent the most serious danger which threatens the man 



226 COMMON DISEASES 

or woman with a damaged heart valve, and that is a 
fresh infection, not merely of the original germ, but of 
any sort. 

Nature's fights in the great prize-ring of life are not 
only to a finish, but of the most remorseless character, 
and not even under rules of such modified brutality 
as those of the Marquis of Queensberry. Disease has, 
unfortunately, not the slightest compunction about 
hitting a man when he is down. On the contrary this 
is its unvarying procedure, and any disease which at- 
tacks the body, whether due to an invading germ, or to 
overstrain, or under-nutrition, will fasten itself in 
deadly grip upon whatever happens to be the weakest 
spot, or point of least resistance, in our bodies, with as 
fell a certainty as the bull-dog flies for the throat. You 
may live for ten, twenty, thirty years with a damaged 
heart valve, so long as you avoid all infections of every 
sort, literally, as if they were pestilences, both by sleep- 
ing and working in a gentle breeze day and night, 
spending plenty of time in the open air, avoiding all 
known sources of contagion, such as coughing and 
sneezing friends, stuffy, ill-ventilated rooms, and par- 
ticularly public gatherings. Or when you are luckless 
enough to "catch" an infection, attack it vigorously 
with local antiseptics and eliminatives, such as your 
family physician will select as most suitable to your 
particular case. 

Fully eight tenths of all valve-defects of the heart 
can be overcome or in technical phrase, compensated, 
so that a state of equilibrium is reached, which will 
last for years and decades, in fact until it is dis- 



HEART DISEASE 227 

turbed by some form of overstrain, or under-nutrition, 
or advancing years, or by a fresh attack of some infec- 
tion; and the last danger is coming to bulk larger in 
our apprehensions than all the former. To keep a clean 
heart, or rather a clean blood, is of as vital importance 
in pathology as it is in theology. How important these 
valve damages are may be gathered from the state- 
ment that in probably at least eight tenths of all cases 
of organic heart disease, the principal seat of the trouble 
is a warped or crippled condition of the valves. 

This brings us to the other great group of diseases of 
the heart — those which attack not the mechanical, 
or valvular, part of the pump, but the propulsive, or 
muscular wall of it. We all know perfectly well what 
we have to do in getting water from a pump with a 
leaky valve, — simply put on more "elbow grease." 
This is precisely what is done by the heart in like case 
and consequently almost every valvular defect is fol- 
lowed by one of two things; either, if so great that the 
heart can scarcely overcome it, a dilating or ballooning 
out of its cavities, or if within its powers an increase in 
the power of its contraction, followed by an actual 
growth of the muscle fibres, so that the heart not merely 
becomes larger and more capacious, but thicker walled 
and stronger — in technical term, hypertrophied. 

Just so long as this increased size and power of the 
heart-wall can be maintained, so long the patient will 
live. The moment that it begins to fail, he fails also. 
In other words our most important problem in "ac- 
complished" heart disease, where the damage has been 
done and the infection and poisons got rid of, is to build 



228 COMMON DISEASES 

up and sustain the muscular power of the heart. This 
has radically changed our attitude toward and treat- 
ment of the man, or woman, with heart disease, in 
several respects. 

In the earlier days of our knowledge and ability to 
recognize damage to the valves, we naturally concen- 
trated our attention chiefly upon these, and as they 
were permanent defects, set about lightening the 
work which would be thrown upon them, and avoiding 
the possibilities of strain in every way. Our patients 
with heart disease were told that they must choose a 
sedentary occupation, which involved as little muscu- 
lar exercise and strain as possible. That they must 
walk slowly on the street, get a bedroom, if possible, 
upon the ground floor so as to avoid climbing stairs, 
must take in fact just as little exercise as was consist- 
ent with earning their living and in every way lessen 
the work of the heart and conserve their strength. 

We soon discovered however that, in the first place, 
this gingerly, soft-footed sort of a life was hardly worth 
living and our patients told us frankly that they would 
rather be dead than go prowling through life with one 
finger constantly on their pulse and the fear of im- 
pending death ever before their eyes. Then we found 
that patients with serious valvular defects had lived 
active useful lives for ten, fifteen, and twenty years, 
before it was ever discovered that they had heart disease, 
and that our patients who took the greatest care of 
themselves often died quite as soon, if not sooner, than 
those who took greater risks. Then it dawned upon us, 
as it had already done centuries before upon a great 



HEART DISEASE 229 

mind in medicine here and there, that the heart was 
only a muscle that happened to be hollow and that 
like all other muscles it could be built up by exercise 
and weakened by disuse; and that if we wanted to in- 
crease the power of the heart muscle we must build it 
up as we would the biceps, by exercise and feeding. 
Then we realized what Sydenham meant, when he 
made his wealthy patients with heart disease get out 
and run behind their own carriages, and why an older 
father in medicine set them climbing mountains. 

Though we cannot, by taking thought, add inches to 
our stature, we can add ounces to our heart, and all 
pure muscle, representing new " horse power." Our 
whole problem now is how to build up as quickly and 
as far as possible the muscular power of the mechani- 
cally damaged heart. The treatment in the beginning 
in extreme cases is of the mildest sort — mere move- 
ments of what is known as passive resistance, such for 
instance, as lifting up the patient's relaxed arm by the 
hand of the operator, and then gently resisting its tend- 
ency to fall back again to the side, thus calling the 
muscles into the mildest possible contraction to assist 
gravity. Then the exercises are gradually, almost 
insensibly, increased day after day until finally the 
patient is able to sit up and move about and take exer- 
cise on his own account. This is necessary in only ex- 
treme cases, with two or more of the valves crippled, 
or in the later stages of an old heart defect, where the 
heart's strength is being gradually worn out and com- 
pensation beginning to fail. 

The vast majority of cases of heart disease, produced 



230 COMMON DISEASES 

as they are by acute infections in young or early adult 
life, have plenty of vigor and recuperative power in 
their heart-muscle which can be built up to al- 
most any required pitch. So that it is not too much 
to say that the awful term "heart disease" which used 
to sound like a sentence of death and cause the sufferer 
to put his worldly affairs in order at once, has lost that 
dread significance and simply means a handicap which, 
under intelligent care and living, can be balanced for 
ten, twenty, or thirty years; often in fact until the pa- 
tient dies of something else. There never was a better 
illustration than heart disease of the truth of the shrewd 
old Spanish proverb "Threatened men live long.'* As 
a philosophically-minded old colleague of mine used to 
put it: "Men with heart disease have a surprising fac- 
ulty of living to act as pallbearers at the funeral of the 
doctor who first discovered it, and condemned them to 
death." 

The recuperative, compensating powers of a healthy 
heart muscle are something almost incredible. But it 
must be well fed in order to grow and keep equal to its 
work. A damaged heart will live and keep the rest of 
the body alive with it, just so long as it is able to pump 
through its own walls a sufficient supply of rich, well- 
aerated blood. Here is the real crux of the modern 
problem of heart disease and the point round which our 
most serious difficulties centre in doubtful cases. 

Laming of the heart muscle may be brought about 
in three ways, two of which are, unfortunately, often in- 
volved or implied, in the original damage to the valves. 
One of these is the direct poisoning of the muscle fibres, 



HEART DISEASE 231 

followed by a greater or less degree of inflammation 
and decay, by the same toxin or germ which has at- 
tacked the valves. The second is injury by the same 
or other toxins to the walls of the tiny arteries which 
supply the substance of the heart itself (known by the 
absurd name of the coronary arteries), so that the 
heart's own blood supply is interfered with. Third, per- 
sistent overstrain from physical labor, especially if 
combined with under-nutrition and bad sanitary sur- 
roundings. 

The first form of damage to the heart muscle (known 
as myocarditis) may occur, like inflammation of its 
lining, in the course of any infectious disease, but fortu- 
nately is much rarer. It is much more serious when it 
does occur, indeed is one of the commonest causes of 
death by heart failure, such as occurs in some infec- 
tions, notably pneumonia. So serious in fact is it that 
it practically plays but little part in the question of 
chronic or "lasting" heart disease. Hearts with any 
considerable degree of myocarditis are scarcely likely 
to survive long enough to furnish any opportunity, or 
time, for compensation, and even if the unfortunate 
patient should apparently recover from the fever, he is 
apt quickly to go down under the first slight shock or 
strain. In fact our prognosis, or forecast, of the pro- 
bable future of a case of heart disease is based much 
more upon the condition, and chances for maintaining 
the nutrition of the heart muscle, than it is upon the 
size and number of the leaks in the valves, except 
where these last are extremely severe. To paraphrase 
Louis the Magnificent, " the muscle, that is the heart ! " 



232 COMMON DISEASES 

The most important single cause of damage to the 
wall of the healthy or of the crippled heart, and the 
one most difficult of practical adjustment is the strain 
thrown upon it by fatiguing and excessive use of 
the muscles of the body. While this kind of strain 
thrown upon the heart within reasonable limits is not 
only not injurious but helpful and curative, when car- 
ried beyond these limits it is damaging and injurious 
to the last degree. Work for the heart, like gymnastic 
exercise for the other muscles of the body, must, in 
order to be improving and upbuilding, be kept well 
within the limits of its strength and only increased 
gradually as these increase. Whenever these limits are 
exceeded and the strain persisted in, work becomes as 
powerful an influence for breaking down and destruc- 
tion as it is in moderation for growth and upbuild- 
ing. 

The sense of fatigue, of tiredness, is as we now know, 
only a symptom of self -poisoning, the piling up in our 
blood of the toxins produced by our own activities, 
the "choke damp" from those millions of tiny explo- 
sions which we call muscular contractions. In work 
within our powers our muscles produce poisons, but 
these are washed out by the blood, burned up in the 
lungs, and replaced by new liquid "dynamite" pro- 
duced from our food and elaborated during rest and 
sleep. But when the work is so heavy, or the strain so 
prolonged and incessant, that this periodic flushing out 
and revictualing cannot be carried out, so that there is 
a steady piling up and constant saturation of these 
fatigue-toxins, then they begin to act like sewage in 



HEART DISEASE 233 

the drinking water — slowly but with a deadly sureness 
and fatality. 

Just as soon as the muscle of the damaged heart 
reaches a point where, from the prolonged and excess- 
ive strain thrown upon it by overwork of other mus- 
cles of the body, it is poisoning itself faster than it is 
being fed, it needs no prophet's eye to see what its 
ultimate fate will be. 

While certain occupations involving heavy muscular 
strains such as coal heavers, expressmen, porters, dock- 
laborers, builders, etc., and others including constant 
severe muscular effort combined with exposure and long 
periods of unbroken toil in emergency, like lumbering 
or mining, must be avoided by the man with heart 
disease, in the vast majority of human occupations 
whether outdoor or indoor, it is more a matter of the 
incessantness of the strain, the hours of work, the sani- 
tary conditions under which the work is done, and the 
food, housing, clothing, and recreation which he is 
able to give himself on the wages earned. A man with 
a moderate degree of heart disease can, fortunately, 
adjust himself to almost any, except a few of the heavi- 
est and most taxing, industrial occupations, and to 
nearly any clerical, professional, or business career, 
providing that he can keep his hours within reasonable 
limits, get proper rest and recreation, and feed himself 
well. 

Obviously, like any other living thing, if a muscle is 
to grow it must be fed and well fed, and this is the point 
of view from which our dietaries in case of heart disease 
are now constructed. That diet is best for a damaged 



234 COMMON DISEASES 

heart which will most abundantly maintain the nutri- 
tion and general vigor of the entire body; which means 
of course that it must be digestible and must not throw 
any undue or excessive burden upon the excretory or- 
gans — the liver, kidneys, or lung — but above all 
must be abundant. Our special and restricted diets in 
heart disease have almost disappeared, except in the 
very earliest stages when it is desired to build up the 
strength as rapidly as possible with as little tax to the 
digestion as may be, on milk, eggs, scraped beef, and 
such like; or in the later stages where from failure of 
the heart-pump, dropsy or waterlogging of various 
parts of the body is setting in, when a brief use of what 
is known as the " dry diet," limiting strictly the amount 
of liquid drunk and used in the preparation of foods, 
may prove helpful in draining the swollen tissues. 

One of the chief reasons why patients with heart 
disease, who have to continue in employments involv- 
ing heavy muscular labor, usually do badly and die 
soon, is the coarse, inadequate, and monotonous food, 
combined with the unfavorable and often unsanitary 
surroundings which their low wages condemn them to. 
While on the other hand the fifteen, twenty, or thirty 
years' survival of patients higher up in the social scale 
is due quite as much to the abundance of their food 
and the wholesomeness of their surroundings as to the 
lighter character of their muscular toil . It is well known, 
proverbial in fact, that we cannot control the heart 
directly, which was probably one reason why it was 
made the seat of the emotions; but indirectly, through 
the levers of work and food, we can make of it al- 



HEART DISEASE 235 

most what we will — short of giving ourselves a new 
one. 

The last great source of danger to the heart muscle 
in heart disease is the nutrition and vigor of the muscle- 
rings in the walls of the blood vessels all over every 
part of our body. The heart is of course only an 
extra large and specially shaped "bunch" of these and 
falls or stands with them in their vigor or decay. In fact 
we are coming to accord to them a larger and larger 
share in the work of the circulation. Their presence 
and action give the blood vessels all over the body the 
power of controlling their calibre. They can shut down 
until the part supplied by them becomes white and 
bloodless, or expand until it becomes red and swollen. 
Thus it is obvious that they can very greatly either 
obstruct or promote the flow of blood, and increase or 
decrease the work to be done by the heart. Not only 
so, but it is strongly suspected that when these little 
rings of muscle surrounding all the arteries expand to 
let the pulse-wave of blood driven by the heart pass 
through them, they do not merely mechanically recoil 
upon it as an Indian-rubber tube might, but throw 
some "heart" into their recoil and actively help to 
drive on the flowing blood. Be this as it may, when- 
ever the muscles in the walls of the arteries and veins 
are paralyzed or seriously damaged, the heart quickly 
becomes inadequate to keeping up the circulation, is 
choked with blood of which it cannot empty itself, and 
dies in acute distension. 

Furthermore, any condition which throws these 
little muscle rings all over the body into a state of 



236 COMMON DISEASES 

spasm, enormously increases the work of the heart, 
causes it to slowly dilate and ultimately thin and 
atrophy its wall until it breaks down and the patient 
dies of heart failure. 

One of the commonest chronic decays, or degenera- 
tions, in the body is a gradual breaking down of these 
tiny muscles in the walls of the arteries and their sub- 
stitution by fibrous tissue, with hardening and loss of 
elasticity, known as arteriosclerosis. This is one of the 
commonest changes, which takes place in old age as 
illustrated in the axiom that "A man is as old as his 
arteries." It may however take place either generally 
or in certain regions of the body at almost any age, 
from early adult life on. While we are still in the dark 
as to the precise, or even most frequent, causation of 
it, two factors play a very important part. 

These are overwork or overstrain, whether muscular 
or mental, but particularly the former, and poisoned 
conditions of the blood whether produced by infections, 
particularly syphilis, tuberculosis, and malaria, or by 
alcohol and lead. In a sense these two causes may 
be reduced to one, inasmuch as they act by produc- 
ing a toxic and unwholesome condition of the blood, 
which poisons the muscle cells of the blood vessels. 
The influence of overwork and overstrain, for in- 
stance, in producing this decay of the walls of the 
arteries is probably less from the actual physical strain 
that it throws upon them than by the chronic auto- 
intoxication by fatigue poisons, which it brings about. 
Although alcohol and lead both seem to have a special 
affinity for these delicate and important muscular 



HEART DISEASE 237 

fibres, yet they both appear to act more powerfully 
through the general disturbances of digestion and 
metabolism which they produce, and which combined 
with their paralyzing effect upon the organs of elimina- 
tion, particularly the kidneys, result in the piling up in 
the body of an excessive amount of waste and other 
self-made poisons. 

Alcohol is peculiarly "Bad Medicine" in this form 
of heart mischief, especially when, as unfortunately 
often happens in those who are engaged at heavy 
manual labor at low wages, it is taken as a substitute 
for food, or as a means of adding palatability to a 
diet which is coarse, monotonous, and badly cooked, or 
attractiveness to the kind of life which accompanies 
such a diet. 

Our next most careful consideration, after providing 
for healthful exercise and abundant food, is to, in every 
possible way, guard against and ward off the develop- 
ment of old age, in the sense of this decay of the arteries. 
Fortunately the same measures which will improve and 
build up the general health, and the same precautions 
against new infections which will protect the damaged 
valves from further destruction, are the measures best 
adapted to meet this danger, with the addition of the 
most careful attention to promoting and maintaining 
at their highest possible efficiency the activities of the 
liver, the kidneys, and the skin. 

It further emphasizes the wisdom of building up the 
general nutrition and letting the heart alone in these 
conditions, that genuine heart disease may be produced 
in hearts with perfectly healthy valves and linings, by 



238 COMMON DISEASES 

persistent or extreme degrees of this arteriosclerosis. 
Partly from the loss of contractile power and partly 
from the narrowing of the calibre of the arteries, which 
occurs when their muscular coat changes to fibrous 
tissue, the work of the heart may be so enormously in- 
creased that it will first hypertrophy, or thicken and 
enlarge, then begin to dilate, with thinning and wasting 
of its walls until it is just as "inadequate" as if the 
valves had been destroyed. This is the type of diseased 
heart which may develop in the course of Bright's 
disease. In extreme cases indeed this ballooning out 
and expansion of the heart may go to such a degree 
that its openings become so distended that the per- 
fectly healthy valves can no longer close them. 

But this general decay of the blood vessels may also 
strike home more closely to the heart in a special 
and somewhat unexpected fashion. Contrary to what 
might be supposed, the heart does not suck up its 
own supply of blood, sponge-fashion, from the current 
that fills and passes through it, but is supplied solely 
by two small arteries given off from the aorta, or great 
main artery, just as it leaves the heart. Whenever this 
general process of arterial decay reaches these two 
small vessels it is obvious of course that the heart's 
own line of supply is cut off or seriously threatened, 
and the outlook becomes grave at once. 

So long as these little coronary arteries remain un- 
touched, the heart still has the power, or at least the 
possibility, of responding to the spur and rising to its 
task, no matter how severe may be the strain which is 
put upon it, or how extensive the process of decay in 



HEART DISEASE 239 

other arteries all over the body may be. In some cases, 
fortunately, these arteries will escape decay for years 
and decades after those of the rest of the body have 
become involved. But in others they may become dis- 
eased first of all and these are the cases which develop 
that strange and exquisitely painful "heart-cramp" 
known as angina pectoris. Any condition which leads 
to the spasm, or blocking, of these tiny twigs may give 
rise to agonizing attacks of pain in the heart, radiating 
out into the shoulders, arms, and hands (as these are 
supplied from the same level of the spinal cord as the 
heart is), accompanied by an extraordinary and dis- 
tressing sensation of impending death. This is the 
reason why this disease is so serious and so apt to prove 
fatal in the long run; though even these deadly seizures 
may occur for years, and especially if they be of the 
form due to spasm of the artery, throughout a consider- 
able part of a lifetime. Sir Walter Scott, for instance, 
suffered from attacks of angina for nearly twenty years 
before the end came. 

This angina pectoris is of special interest as forming 
almost the sole exception to the general rule, that, 
contrary to popular impression, heart disease is 
seldom attended by pain in the region of the heart. 
Stranger yet, it is not often accompanied by what is 
commonly known as palpitation — sudden irregular 
movements of the heart, which attract the attention 
of the patient himself. In spite of the fact that it is 
the classic seat of the emotions and peculiarly tender 
and sensitive, so that "cut to the heart," or "heart 
broken" are synonyms for the most exquisite refine- 



240 COMMON DISEASES 

ments of agony, the actual heart itself is singularly in- 
sensitive. Very few even of its most serious diseases 
produce much more than a sense of pressure and con- 
striction of the chest, with shortness of breath. Even 
when its beats have become so irregular that no two 
of them are of the same force and every fourth or fifth 
one skipped entirely, the patient will not be conscious 
of anything wrong with the beating of his heart until 
he puts his hand upon his pulse. 

The vast majority of patients who come to us under 
the impression that they have heart disease, are suf- 
fering from nothing more illustrious than gas on the 
stomach. This unromantic condition is also the most 
frequent cause of those sudden flutterings, or hop-skip- 
and-jump movements of the heart, which so terrify the 
nervous. The heart is separated from the upper sur- 
face of the stomach only by a thin layer of muscle, the 
diaphragm, and when it is ballooned upward by the 
accumulation of gases, due to indigestion, it very com- 
monly first displaces and then produces a distressing 
and uncomfortable pressure upon the heart as well as 
upon the lungs. This is why most attacks of "heart 
pain" and palpitation can be best relieved by a dose of 
peppermint or other aromatic gas-expeller. 

When the coronary artery has become damaged or 
blocked, we begin to get not merely a loss of strength 
and contracting power, but also a gradual decay of the 
heart muscle itself. If the muscle fibres break down 
and are replaced by fibrous tissue, we get what is 
known as "brown atrophy" of the heart; while if they 
change into fatty tissue we get the much better known 



HEART DISEASE 241 

and more widely dreaded, but less common, fatty 
degeneration of the heart. 

When the heart begins to fail and can no longer keep 
up the struggle, we get first shortness of breath from 
its inability to properly pump the blood through the 
lungs, then dropsy, or "water logging" of the tissues 
from failure of the central drainage pump. This usu- 
ally involves first the feet and ankles, as these are the 
lowest points in circulation, where the sense of gravity 
is most felt, then the lungs, increasing the difficulty of 
breathing, then the liver, gorging and distending it so as 
to block and impair both the digestive power and the 
general power of resistance of the body against invad- 
ing germs. By a merciful provision of Nature, the 
heart seldom fights out the struggle to the bitter end, 
but when the resisting power of the body has been 
reduced below a certain level the attack of some wan- 
dering infection, most frequently a pneumonia, or a 
bronchitis, or even an influenza, storms the citadel and 
cuts short the scene. These are technically known as 
"terminal infections," and are the commonest imme- 
diate cause of death in a great variety of slowly pro- 
gressive conditions of disease and enfeeblement, in- 
cluding old age. They are Nature's coup de grace — 
her "stroke of mercy" to put us out of our pain. 

Another complication, which may and often does 
end the scene in heart disease, is of a somewhat unex- 
pected character and that is the rupture or blocking of 
a blood vessel in the brain. It may not be generally 
known, but an apoplexy or "stroke of paralysis," is not 
really a disease of the brain or nervous system itself, 



242 COMMON DISEASES 

but of one of the blood vessels supplying it. Both 
forms of this are peculiarly likely to occur in heart 
disease, for during the original inflammation of the 
valves, or later in the process of healing, or in a 
secondary attack of endocarditis, little clots or frag- 
ments of fibrin may be washed off the surface of the 
diseased valves and floated along in the blood current 
until they reach some artery which is too small for 
them to go through and which they promptly plug up. 
Should this blocking occur in most parts of the body, 
say for instance, in the muscles or fat or even in the 
lung or liver, it would usually produce only a local and 
trifling disturbance; though if germs happen to be en- 
tangled in the clot they might set up a new point of 
inflammation, or an abscess. If, however, the clot hap- 
pens to lodge in even a very tiny artery in certain 
areas of the brain, it will produce serious disturbance 
at once, ranging all the way from parafysis of some 
organ, or destruction of some sense, to widespread 
paralysis, or even immediate death. Later in the dis- 
ease apoplexy, or paralysis, by rupture of a blood ves- 
sel, may occur because the process of general arterial 
decay has reached the arteries of the brain and changed 
their elastic muscular wall not merely into fibrous tis- 
sue, but even into calcareous, or chalky stuff, of ex- 
traordinary brittleness. 

Barring, however, apoplexy and angina, there is 
comparatively little danger, in even organic heart 
disease, of that sudden death which its victims are 
supposed to live in the constant shadow of. Few 
diseases give louder and more timely warning of im- 



HEART DISEASE 243 

pending danger than heart disease, and there are gen- 
erally anywhere from six to a dozen threatening at- 
tacks of heart failure before the final one comes. Take 
care of your muscles and your stomach, and don't 
worry about your heart, is the best advice for those 
whom Fate has saddled with this defect. 

As the heart is the source of supply for every organ 
and tissue in the body it is naturally, next to the brain, 
the most extensively connected "Private Exchange'* 
in the whole body telephone-system. In one sense it 
deserves its reputation for tenderness, in that it is 
so exquisitely sympathetic with every imaginable dis- 
turbance that takes place in every other part of the 
body, and even with mental shocks and distresses. 
While its commonest and most serious disturbances 
are due to, literally, scars and bruises received in life's 
battle, especially the battle with the "bugs," yet it has 
a score or more of functional disturbances, due to in- 
fluences exerted upon it through the nervous system 
by stresses in other parts of the body. Thus, certain 
drug foods like tea, coffee, and tobacco will, through 
their influence upon the nerves supplying it, throw it 
into a highly irritable and excitable condition; but 
such disturbances are neither frequent nor serious and 
usually only occur in a small group of peculiarly sus- 
ceptible individuals, like those, for instance, who are 
poisoned by strawberries, shellfish, cheese, sage, etc., 
or from excessive use of the drugs. Their chief im- 
portance, in fact, is when they happen to fall upon 
a heart which is already diseased or beginning to be, 
when of course they may do serious injury. 



244 COMMON DISEASES 

Other curious diseases of the heart are accompanied 
by very marked changes in its rhythm, such as the 
"slow" heart known as Bradycardia (heart-block), in 
which the beats go down from the normal seventy -five 
to fifty, forty, and even thirty beats per minute; or at 
the other extreme, the "runaway" heart, Tachycardia, 
which races along at one hundred twenty, one hundred 
forty, and even one hundred eighty beats to the minute; 
but these, while serious when they occur, are so rare 
as to be rather among the curiosities of medicine. The 
last is associated with an over-secretion of the thyroid 
gland, and the former with a curious break between 
the auricles of the heart above and the ventricles below, 
so that the former may be beating twice or even three 
times as fast as the latter. 

There is also one exception to the statement that 
diseases of the heart are acquired, not congenital, 
wounds received in hard battle in defense of the body 
rather than faults of its own construction, and that is 
a singular form of heart-defect with which some unfor- 
tunate infants are born, known as the persistent fora- 
men ovale. During our life before birth, the blood from 
the right side of the heart, as it obviously cannot be 
pumped through the lungs, passes right on into the 
left side of the heart through an oval opening, or 
foramen, in the dividing wall. This normally closes at, 
or very shortly after, birth; but in about one child in a 
thousand it fails to do so, and consequently the impure 
or venous blood from the right side of the heart mixes 
perpetually with the pure or arterial blood of the left 
side, and the poor youngsters can thus never get their 



HEART DISEASE 245 

blood properly aerated and purified, and have in con- 
sequence, blue lips, blue finger tips, and pale, ashy 
complexions, and gasp for breath on the slightest sus- 
tained effort. These little unfortunates are popularly 
known as "blue babies," and mercifully seldom survive 
for more than a few days or weeks after birth ; though 
they occasionally linger on until the sixth, eighth, or 
even twelfth year of life before they succumb. 



CHAPTER XII 

SEA-SICKNESS 

SEA-SICKNESS is one of those unfortunate mal- 
adies which are inherent in the nature of things. 
It is not caused by a bug — would that it were, for then 
we could run it down and kill it ! It is not due to any- 
thing that we have done which we ought not to have 
done, or to anything left undone which we ought to 
have done. Its why and wherefore is simply that the 
sea is the sea, and we are land animals. The most 
striking characteristic of the sea is its fluidity, its per- 
petual motion, the fact that it won't "stay put "; and 
it simply transfers that characteristic to us and our 
livers and our dinners when we embark on it. 

Sea-sickness is in one sense a mental disease, 
though, like most such, it is utterly incurable by mental 
influence. It is a violation of our most sacred confi- 
dence, the shipwreck of our faith, as it were, the shak- 
ing of our deepest and surest belief, that the earth be- 
neath our feet is solid, fixed, immovable. When the 
plank substitute for this solid earth begins to dance 
and plunge and gambol beneath our feet like a school 
of porpoises or a frisky colt, then the foundation of all 
our beliefs and adjustments is broken up, the bottom 
literally drops out of our cosmogony. Our heads reel, 
our senses swim, our brain centres cry out in agony and 
call upon the ever-ready stomach to voice their woe. 






SEA-SICKNESS 247 

Never shall we be able to cure sea-sickness, so long as 
the earth is the earth and the sea is the sea and we " of 
the earth earthy," unless we can invent some form of 
deck which will behave with the staidness and sobriety 
of terra firma. 

This much it is important to grasp firmly for the 
understanding of our problem, that sea-sickness is not 
a matter of the stomach, nor of the food that is put 
into it, nor of the bile, but solely and absolutely of the 
brain in general, and of the balancing centres and 
mechanisms therein in particular. Any influence that 
disturbs these centres will produce this curious and 
almost absurd form of vomiting, whether it be the mo- 
tion of a swing or of a railway train, or that external 
toxin of the yeast germ which men delight to pour 
down their throats, the toxins of a fever, the pressure 
of a tumor, or an earache, or a blow on the head. Vo- 
miting of this sort is termed "central," from the fact 
that it is due to impulses sent out from the brain, and 
the stomach is merely the passive agent of the brain 
centres. Sea-sickness is literally "brain-sickness," due 
to the breaking up, the confusing, at one sweep, of all 
our preconceived notions of our relations to the visible 
and tangible universe about us. 

I am fully aware that it is, at first sight, most diffi- 
cult to believe that a malady which expresses itself so 
obviously and unmistakably through the stomach has 
realty nothing to do with that organ primarily, but it is 
nevertheless true. Not only has the stomach nothing 
whatever to do with initiating the distressing series of 
events and sensations leading up to the rejection of its 



248 COMMON DISEASES 

contents, but its part in the tragic act itself is a purely 
passive one. Its powerful and well-developed muscular 
walls take no part whatever in emptying it of its con- 
tents — they only play the negative one of relaxing 
the bands which close the upper or gullet entrance of 
the stomach. Then the diaphragm from above comes 
down with a Wh-o-o-op, and the big muscles of the ab- 
dominal wall come up with a Wh-o-o-sh, and the con- 
tents of the luckless stomach are caught between the 
two and squeezed out like a minority stock-holder. 
The awful, agonizing gasp that precedes "playing Jo- 
nah" is simply the sucking in of air by our diaphragm 
in its downward swoop upon the stomach. Strictly 
speaking, you are not "sick at your stomach," but 
"nauseated in the region of your diaphragm." "Nau- 
seated," by the way, is a peculiarly appropriate term 
in this connection, as its derivative meaning is literally 
"pertaining to the sea," or "occurring upon the sea," 
and comes from the same Greek root that enters into 
"nautical" and "navigate." 

So you may rid your mind of the idea that any con- 
dition of your stomach or digestion, any food that you 
may have eaten or refrained from eating, or any dis- 
order of the liver from which you may be suffering be- 
fore embarking, can affect the fact or the degree of 
your sea-sickness. Obviously, any catarrhal or in- 
flamed condition of the stomach that may be present, 
or any articles of diet that are specially irritating or 
indigestible, will be likely to render the stomach even 
more easily thrown off its balance, and make its suffer- 
ings under the fierce man-handling of the diaphragm 



SEA-SICKNESS 249 

more severe. But apart from this there is absolutely 
no connection whatever between the stomach or its 
contents and sea-sickness. Eat anything in reason that 
you like before going on board, and the first thing that 
appeals to you when you begin feebly to hope that you 
are not going to die, after all — and you will suffer less 
than by either starving or dieting yourself. 

When you have once passed the crisis and begun to 
adjust yourself, the most unlikely and indigestible of 
foods that taste good will be retained and digested, 
while before you have reached that blessed haven the 
mildest and most harmless of slops will be indignantly 
rejected. The experience of thousands of years has 
shown that remedies that act upon the stomach di- 
rectly, such as pepsin and other digestives, aromatics, 
alkalies, champagne, bitters and stomach tonics of all 
sorts, have no more effect upon the malady than if 
they were poured down the back of the patient's neck. 
The only thing to do is to give the nerve centres the 
treatment recommended in the nursery rhyme for 
Little Bo Peep's lost sheep: Leave them alone and 
they '11 come home and bring the stomach behind them. 

Though sea-sickness is chiefly a disturbance of the 
brain, the structure that suffers most severely lies just 
outside of that organ, at the base of the skull, in close 
connection with the organ of hearing. This is a very 
curious and ingenious little group of tiny canals, three 
in number, known from their shape as the semicircular 
canals. These canals are supplied by a division of the 
auditory nerve, and were for a long time regarded as a 
part of the internal ear. It was, however, discovered 



250 COMMON DISEASES 

some forty years ago that injuries or diseases -.which 
affected these tiny canals promptly produced a loss of 
balancing power on the part of the individual. Look- 
ing at them again from this point of view, it was quickly 
seen that each one of these tiny canals, filled with fluid 
and its interior bristling with delicate processes sup- 
plied by sensitive nerve twigs, formed a living spirit- 
level, and that their number — three — was for the 
purpose of providing one for each of the three dimen- 
sions or directions in which movement is possible — 
backward and forward, upward and downward, and 
sideways. If the backward-and-forward canal in a 
pigeon, for instance, were pierced with a needle, after 
the bird had come out from under its anaesthetic and 
was allowed to fly, instead of flying straight forward 
it would pitch head-over-heels in a headlong series of 
somersaults. If the up-and-down canal were pricked it 
would fall over backward; if the sideways canal, it 
would roll over and over from side to side. After a few 
days, when the prick had healed up, the bird would 
completely recover and fly and balance itself as well as 
ever. A congenital defect in the nerve supplying one of 
these canals gives a breed of Japanese white mice the 
curious habit of whirling round and round, and they 
are hence known as "waltzing" or "dancing" mice, 
and highly prized as curiosities. The characteristic has 
become hereditary, and crops out in their crosses in 
Mendelian proportions. 

So delicate and accurate is the adjustment of these 
tiny spirit-levels that, even after we have been blind- 
folded and our ears plugged up with cotton, and are 



SEA-SICKNESS 251 

laid upon a table delicately balanced on the top of a 
doll-head pivot, if our balance is disturbed by tilting 
this even a fraction of an inch we can instantly detect 
the movement and tell accurately in what direction it 
has occurred. If we remember that, walking or stand- 
ing, balancing ourselves upright upon our two feet is 
the most delicate and difficult muscular feat of which 
we are capable, and that these tiny canals are on the 
alert every moment of our waking and sleeping hours 
to register every possible disturbance of our equilib- 
rium that might threaten a fall, we are in a position to 
understand what calamities descend upon these organs 
of uprightness when we embark on the bounding billow. 
When a moderate breeze comes up, one canal is sure 
that you are falling down a well, another that you are 
pitching backward off a cliff, another that you are 
rolling over and over down a roof. All the time your 
eyes assure you that you are lying quietly in bed, though 
you know this is a lie. Is it any wonder that things 
happen? 

Finally, they all shriek aloud at once at the top of 
their voices, each saying a different thing, and — well, 
you know the rest! "Getting your sea-legs" is simply, 
first, a realization that these various losses of balance 
are not going to hurl you headlong and break your 
bones; and second, that by crooking your knees so as 
to catch the deck whenever it happens to hit the soles 
of your feet, and giving your body a gentle roll to 
match that of the ship, only in the opposite direction, 
you can maintain a kind of an apology for an equilib- 
rium — a sort of trial balance, as it were. 



252 COMMON DISEASES 

Years of this sort of thing have given the charac- 
teristic jovial roll and cheerful swagger to the gait of 
Jack on shore. The tendency to roll often persists for 
several days after you have regained terra firma and 
gives you the impression that good old Mother Earth 
is pitching and tossing under your feet like the rolling 
deck you have just quitted. If you are going to live " a 
life on the rolling wave," you must acquire a rolling 
gait to match! 

It is, of course, obvious that the more conflicting 
messages your brain is receiving as to what is hap- 
pening to your precious balance the greater the result- 
ing confusion will be. This explains why, upon com- 
paratively calm waters, some individuals will be made 
sea-sick literally through their eyes. That is to say, 
the slight rolling movements which are not severe 
enough to distress their semicircular canals will, if 
their not-overhearty assurances be contradicted by 
messages from the retina to the effect that the horizon 
is moving up and down, be sufficient to cause confusion 
and start the calamity. Under these circumstances, 
relief can sometimes be obtained by simply closing the 
eyes and at the same time lying down or reclining in 
a comfortable position. In severe pitching, however, 
which like the darkness of Egypt can be felt, this expe- 
dient is of no avail, and, except in mild, borderland 
conditions, the eyes have little or no effect upon sea- 
sickness, though they will, of course, aggravate the 
suffering if they are kept open, by providing another 
source of confusion. 

Another factor which enters into this disturbance of 



SEA-SICKNESS 253 

balance is our position. Generally speaking, sea-sick- 
ness is more easily produced and more likely to occur in 
the standing or upright position, and this is for two 
reasons: first, it is in the upright position that the 
maintenance of our balance is most difficult and re- 
quires most constant watchfulness and effort; second, 
that as the actual disturbance of equilibrium occurs in 
the head, the further the head is separated from the 
seat of commotion — the deck — the longer the lever 
by which it is hurled through space, and consequently 
the more violent the motion. A rough illustration of 
this upon a large scale is the much greater amount of 
motion and pitching that occurs at the crosstrees or 
top of a mast than on deck. Even on a comparatively 
calm day, passengers who can stand the amount of 
movement on deck with perfect comfort will be made 
desperately sea-sick in twenty or thirty minutes by 
climbing up to the crosstrees. The nearer the head 
can be placed to the plane of motion the less this ampli- 
fication of the movement. So the recumbent position 
is usually the best one to assume in sea-sickness. The 
slight increase of movement produced by lifting your 
head from the pillow will, perhaps, increase the agony 
a trifle, and even precipitate an explosion which would 
not otherwise have occurred — but what is that in the 
depths of the abyss! 

That the calamity is chiefly due to disturbances of 
our hard- won equilibrium, violations of our deepest 
sense of propriety, as it were, is shown by the curious 
immunity generally possessed by children, and to a 
certain degree by those who are entering upon their 



254 COMMON DISEASES 

second childhood, the aged. Children under ten years 
of age suffer but slightly from sea-sickness, and infants 
in arms, by a merciful dispensation, practically not at 
all. This immunity is evidently in direct proportion 
to the degree to which they have learned to walk and 
to the extent of that accomplishment. Their sense of 
equilibrium is still in a plastic and adjustable stage. 
They tumble and roll and pitch head downward and 
turn somersaults and fall out of things with a cheerful 
immunity from headaches, giddiness, or discomforts of 
that description, that makes them the envy of adult 
beholders. There may also be an ancestral element in 
it, "Intimations of Immortality," echoes of a previous 
stage of happy existence in the treetops, where swaying 
and pitching and tossing were normal conditions of life. 
A somewhat similar immunity is possessed by ani- 
mals, though this is not quite so complete. Cattle, 
horses, and sheep, shipped across the Atlantic, not in- 
frequently suffer severely during rough weather and 
storms, refusing to eat, groaning and pitching about, or 
lying down persistently, apparently unable to stand 
up from giddiness, though they comparatively seldom 
vomit, as this is a very difficult performance with them 
on account of the peculiar construction of their stom- 
achs. This disturbance sometimes becomes so severe in 
horses as to result in serious injury and even death, 
especially in thoroughbred horses with their highly 
sensitive nervous organisms. One member of the 
grass-eaters, the camel, is quite susceptible to mat de 
mer, and goes through the whole figure, including 
vomiting. The carnivora, cats and dogs especially, are 



SEA-SICKNESS 255 

but little affected by the motion of waves, but in rough, 
weather they, too, succumb and give a very perfect 
imitation of the real thing. One group of animals seems 
to be entirely immune, curiously enough, and this 
includes our nearest relations, the monkeys and the 
apes. This is probably due to the fact that they are 
natural trapeze acrobats, born circus performers, and 
the pitching of a ship would be comparatively mild 
contrasted with their headlong plunges from one tree- 
top to another, their seesaw rides on the slenderest 
branches, and their habit of swinging by their tails, 
head downward. Birds seldom suffer from sea-sickness, 
and appear to adjust themselves to the rolling of the 
ship as readily as to the swaying of the treetops in a 
gale. 

Vomiting, though one of the most striking and dis- 
agreeable symptoms of sea-sickness, is only one of a 
dozen. Quite as frequent and almost as distressing is 
headache. This will often be the only symptom of the 
malady in calm weather or in partially-seasoned travel- 
ers. In some annoying instances it will not occur dur- 
ing the voyage at all, but develop with great severity 
after the victim has landed on the other side, and 
haunt him for days or even weeks. Another form of 
distress is severe neuralgic attacks, which may occur in 
the back, in the side, in the shoulder, or in one of the 
limbs. Disagreeable sensations, flashes of heat and 
perspiration, rapidly followed by shivering and cold- 
ness, are also very common. In fact, an exaggerated 
susceptibility to cold is probably one of the commonest 
symptoms of sea-sickness, from which very few travel- 



256 COMMON DISEASES 

ers, even the most seasoned and robust, entirely es- 
cape. Some, though not in the slightest degree nau- 
seated, will be so distressed by it that they are utterly 
unable to keep comfortably warm on deck and are 
obliged to stay in their staterooms for the sake of 
warmth. This is why wraps and rugs of every descrip- 
tion are in such constant demand on a sea-voyage. 
Very common, also, is a profound sense of depression, 
with or without melancholy. Even in those in whom 
it does not reach a disagreeable degree this feeling will 
produce an utter inability to concentrate the mind upon 
anything. Little mental work is ever done at sea. 

Most of the benefit supposed to be derived from sea- 
voyages is due to the lively and refreshing contrast and 
sense of relief produced by the return of the normal 
state of mind and body when on shore once more. You 
are n't really any better than when you started, but 
you are so much better than on the way over that you 
feel as though you had gained ten or fifteen pounds. 

That this distressing disturbance of balance, of our 
sense of equilibrium, of dignity and propriety if you 
will, is the real cause of sea-sickness is further shown 
by the fact that it is not even necessary to go to sea to 
get seasick. The familiar ghastly sensations of dizzi- 
ness followed by nausea, which can be produced in 
many of us by swinging too high or too long in swings 
or merry-go-rounds, is of precisely the same character 
and, if the motion be persisted in long enough, will give 
rise to just as distressing sensations and eruptions. 
Many individuals, particularly women, will suffer ex- 
actly the same series of distresses from traveling on 



SEA-SICKNESS 257 

railway trains, especially when the track is unusually 
curved and tortuous, as when going through moun- 
tains. Others will be similarly affected by long jour- 
neys in wagons or carriages. Particularly was this the 
case in the old-fashioned stage-coaches, where journeys 
were continued day and night; even strong, hardy men 
were sometimes made so wretchedly "stage-sick" that 
they would be obliged to break the journey for several 
days to recover. Travelers in the East who have un- 
dertaken long journeys on the backs of camels describe 
as one of the most uncomfortable experiences of the 
journey the agonizing attacks of nausea, headache, 
giddiness, and vomiting which come on about the 
third day of the trip, due to the pitching and sway- 
ing gait of the "ship of the desert." Our mental- 
influence friends, however, would probably challenge 
this illustration, alleging that the symptoms were due 
to suggestion and expectancy, because the travelers, 
knowing that they were to be carried upon a ship of 
some sort, naturally expected to be sea-sick. 

It is frequently asserted that expectancy, vivid an- 
ticipation, and the firm belief that you are going to be 
sea-sick play a large share in bringing on an attack. 
This, however, is largely illusory and due to the fact 
that nausea is a purely cerebral symptom — indeed, 
almost a mental one — and can be produced by a score 
of different disagreeable sensations, notably, disagree- 
able smells or disgusting sights or sounds. Even such 
a purely mental impression as a sudden fright or the 
receipt of very bad news will make us faint and 
nauseated. Consequently it is not to be wondered at 



258 COMMON DISEASES 

that the mere occurrence of any of the rich sea-smells, 
or the sound of the wind in the rigging, or — in some 
exceedingly susceptible individuals — the sight of a 
ship or of the open sea will produce a momentary sen- 
sation of distress. I have even known some individuals 
who suffered frightfully from sea-sickness to be so 
sensitive that the sight of a vivid and realistic painting 
of a sea-scene was enough to make them cover their 
eyes and hurry past; others would shudder at the mere 
sight of a deck steward; and many would be almost 
made sick by the first whiff of the disinfectant which 
had been used in the basins and cans on shipboard. 
But that these preliminary qualms, these purely men- 
tal anticipations, will produce real sea-sickness, unless 
followed up by the necessary pitching and tossing, 
there is absolutely no evidence to show. 

There are thousands and thousands of instances now 
on record of individuals who were firmly convinced, 
either from previous fortunate experiences, or from the 
assurance of their friends or physicians, or because 
they had taken some "sure-cure" remedy, that they 
were never going to be so silly as to be sick at sea, and 
who have promptly proceeded to suffer all the tortures. 
On the other hand, hundreds of phenomenally bad 
sailors who are even nauseated by the sight of sea- 
water in a bathtub, and who go on board with the 
firmest of convictions that no power under heaven can 
save them from being sea-sick, make a perfectly serene 
and comfortable voyage, if only the winds and the 
waves happen to be favorable. 

A most curious fact about this condition is that our 



SEA-SICKNESS 259 

adjustment to this new style of tight-rope balance is 
never absolute and complete. Take the grizzled cap- 
tain or veteran boson of an Atlantic liner, who has 
followed the sea from boyhood and has hundreds of 
crossings to his credit, and put him aboard a pilot boat 
or a Gloucester schooner in a lively blow, and ten 
chances to one he will be heaving his very soul up in 
ten or twelve hours. 

A friend of mine recently made the trip to Naples 
from New York in one of the great Mediterranean 
liners. From there he took a little local steamboat, 
scarcely bigger than a launch, for the island of Capri. 
The crossing takes a little over two hours. With him 
happened to embark the first mate and the purser of 
the liner, both of whom had a curiosity to see Capri. 
One of the sudden squalls for which the Bay of Naples 
is famous, or rather infamous, came up. Everybody on 
board, with the exception of the crew, became agoniz- 
ingly sea-sick, and among the first to succumb were 
the two blue-coated, gold-laced, veteran sea-dogs. 

What is even more distressing is the fact that cer- 
tain luckless individuals, who for various reasons have 
elected or been trained to follow the sea as a means of 
livelihood, such as sailors, ships' officers, ships' clerks, 
and even officers and enlisted men in the navy, never 
quite get over being sea-sick. I have heard of four or 
five within the past year, one a yeoman in the navy, 
another a naval officer of many years' service, who were 
uncomfortably sea-sick for a few hours or days every 
time they went to sea, or would be more or less acutely 
affected whenever a storm came up. A classical in- 



260 COMMON DISEASES 

stance is the case of Darwin, who was so wretchedly 
susceptible to the motion of the sea that during the 
whole eighteen months of his now immortal " Voyage of 
the Beagle," which gave him his first brilliant concep- 
tion of the Origin of Species and lard the foundation of 
his fame, he scarcely passed a single day, and never a 
week, without suffering from sea-sickness. Day after 
day he would sit with dogged persistence at the table 
in his cabin, working over his specimens, dissections, 
and notes until his reeling stomach and aching head 
could endure it no longer, and he would lie down on a 
couch alongside his work, to rise and return to the 
attack again in half an hour or an hour. 

As for the treatment of sea-sickness, the least said 
the soonest mended. The only way to remove the 
cause of the malady is to stop the ship from pitching or 
throw the patient overboard, and neither of these is 
feasible, though, at certain stages in the calamity, some 
sufferers would almost welcome the latter. Fortu- 
nately, the demon of mat de mer is as harmless as he is 
vicious. Few things are more certain on this mundane 
sphere than that ninety-nine per cent of even the most 
acute sufferers from sea-sickness will recover their com- 
fort and their self-respect in from two to four days, and 
that nine hundred and ninety-nine out of every thou- 
sand will be not a whit the worse for their distressing 
experience. Almost the only cases in which sea-sick- 
ness produces permanent injury are those of individu- 
als who are either in the last stages of serious and fatal 
disease, or are suffering from conditions that render 
them liable to hemorrhage from the stomach or from 



SEA-SICKNESS 261 

the lungs, or other conditions in which the mere 
mechanical strain of the violent and prolonged vomit- 
ing may produce dangerous results. The best and 
most philosophic course to pursue is to set your teeth, 
"lay low," and stand it until such time as Nature has 
adjusted herself to the situation. You will avoid nearly 
half the discomforts of the experience by strictly re- 
fraining from doing anything whatever to hasten the 
process of cure. Don't take anything for it; don't eat 
anything until you feel like it, and then only what 
you happen to fancy, not what some officious fiend in 
human shape assures you will be "good for you"; and 
don't attempt to go up on deck until you are able to 
stand up with comfort in your stateroom. There never 
was a baser mocker than the oft-repeated assurance 
that "the fresh air will do you good" in sea-sickness. 
Little or nothing can be done for the radical cure of 
the malady except on the classic principle laid down by 
Drummond's habitant : — 

" Den de win' she can blow lak hurrican'. 
An' s'pose she blow some more. 
But you can't get drown' on Lac St. Pierre 
So long's you stay on shore." 

Can anything be done to mitigate the agony? As we 
have already noted, diet, digestives, gastric tonics or 
sedatives, or any other methods aimed directly at the 
stomach or its contents are usually as worthless in 
practice as they are absurd in theory. One of the oldest 
remedies on record is the swallowing of a fish which 
had been taken out of the stomach of another fish! 
Any stomach that could digest that insult certainly 



262 COMMON DISEASES 

ought to be proof against mat de mer. But we grieve to 
state that the majority of the modern sure cures and 
preventives against sea-sickness are as rational in 
character and as effective in their results as this 
ancient prototype of theirs. 

If the voyage is to be only for a night many even 
poor sailors, going on board in the late afternoon or 
early evening and going to bed at once before they are 
clear of the harbor, will be able to get to sleep and 
go through the night undisturbed, arriving at their 
destination next morning with, perhaps, no more than 
a slight headache. But this, of course, is only where no 
really rough weather is encountered. 

On a long voyage there is not much virtue in these 
tactics, since you have to "have it out" with Neptune, 
so to speak, sooner or later. On general principles the 
best course, perhaps, for most travelers to adopt is to 
stay on deck as long as their comfort will permit, but 
to beat a hasty retreat to their staterooms just as soon 
as they feel reasonably sure that something is going to 
happen, without waiting to be too sure of it! They 
will certainly suffer less from the inevitable there than 
on deck, and get over it sooner. It will not infre- 
quently happen that they will be able to go into a half- 
drowsy, half -comatose condition which scarcely distin- 
guishes day from night and "dree their weird" or 
serve their time in that condition, without any very 
violent discomfort. Make up your mind that you will 
not be interfered with or interrupted by anybody or 
anything whatever until either the ship goes to the 
bottom or you feel better, and you will often avoid two 



SEA-SICKNESS 263 

thirds of the acute agony of the attack. If you find 
yourself compelled to vomit drink all the water or soda 
water that you want. The diaphragm will empty the 
stomach according to orders from headquarters about 
every so often whether there is anything in it or not, 
and it is much more comfortable to have something 
there for it to work on. 

The only remedies that have the slightest effect in 
either preventing or mitigating this calamity are those 
that deaden or dull the entire nervous system — the 
so-called narcotics and sedatives — opium and its 
derivatives, chloral, alcohol, and the bromides. All of 
these, however, except the last two, are such dangerous 
poisons in themselves and are so apt to be followed by 
unpleasant after-effects of their own that it is very 
seldom judicious or justifiable to use them as remedies 
against such a harmless disease. In fact, their use is 
almost entirely restricted to those rarer cases already 
referred to in which it is imperative to check the vomit- 
ing at all costs. Bromides and alcohol, however, have 
many enthusiastic backers, both popular and medical, 
and there appears to be little doubt that if any one is 
willing to saturate himself to the point of slight drowsi- 
ness and unsteadiness of gait with either of these inter- 
esting substances he can very much modify, and even 
at times entirely escape, the worst discomforts of sea- 
sickness. 

Most of us would, I think, about as lief be nauseated 
and made unsteady on our pins by Neptune as by 
alcohol or bromides, and, when we further consider 
the later penalties that have to be paid in the shape of 



264 COMMON DISEASES 

of the all- too-familiar agonies of "the morning after," 
we would really prefer the disease to the remedy. How- 
ever, those who suffer very severely and are willing to 
saturate themselves with bromides under the eye of 
their family physician can, in a considerable percent- 
age of cases, escape to some extent at least the miseries 
of the voyage. 

After the calamity has once fairly set in remedies of 
any sort are of exceedingly little value, for the obvious 
reason that the stomach cannot retain them long- 
enough to allow of their being absorbed. In those 
cases in which headache and giddiness and depression 
are the principal symptoms a good deal of relief can 
be obtained by moderate doses of aromatic spirits of 
ammonia. 

One of my friends who was a very poor sailor, but 
a most inveterate traveler, gleefully assured me once 
that he had discovered an absolute and sovereign cure 
for sea-sickness. "I just go straight down to my berth 
as soon as I get on board, Doctor, and tell the steward 
to bring me a hot whiskey toddy every hour until he 
finds me asleep. Then, whenever I wake I ring for 
another toddy, and in that way I go clear across the 
Atlantic without ever once being sea-sick !" 

"But," I mildly expostulated, "don't you feel 
pretty wretched when you finally come up on deck?" 

" Oh, I never come up on deck, Doctor. I just stay 
there and enjoy myself the whole way over!" 



CHAPTER XIII 



HOW WE GROW DEAF 



SOME men are born deaf, some achieve deafness, 
and some have deafness thrust upon them. 
Broadly considered, the second class is far the largest 
of the three. We still take too many of our calamities 
lying down and fail to fight hard enough against our 
fate — not that we were much to blame for our fatal- 
istic attitude toward deafness up to, say, a quarter of a 
century ago. Not only had we been taught from time 
immemorial to regard the dulling of the delicate sense 
of hearing as one of the inevitable penalties of advanc- 
ing years, but the cure of deafness, after it has once 
been achieved, was — and, alas, is yet — one of the 
discredits, even disgraces, of medicine. 

Even to-day the doctor is not very hopeful of curing 
deafness in the sense of restoring hearing which has 
been lost for any considerable length of time; but his 
attitude toward the condition has been completely 
revolutionized by the discovery that deafness does not 
come by chance or by some inevitable process of 
Nature, but is due to definite and well-recognized 
causes, three fourths of which are preventable. The 
great majority of cases, even of chronic and established 
deafness, can be prevented from getting any worse and 
usually improved a little, while nine tenths of all cases 
can be prevented entirely, either by avoiding their 



266 COMMON DISEASES 

causes or by taking them in hand as soon as the first 
sign of trouble with the hearing is noticed. 

By the mercy of Heaven, the first attack of deafness 
is never permanent, with a few rare exceptions involv- 
ing the nerve of hearing itself. The calamity gives fair 
warning of its approach — whom the gods would fain 
destroy they first make sneeze. Our hearing is lost, 
not all at once, or even half or a quarter at once, but by 
tiny successive fractions, each due to a fresh attack of 
the disease which causes deafness. And that disease, 
nine times out of ten, is nothing more formidable than 
our old friend, or rather most intimate enemy, a com- 
mon cold, which travels up the tube to the ear from the 
nose or throat. 

The motto of our crusade against deafness emphatic- 
ally is: "Despise not the day of small things." The 
only way to cure deafness is to treat it before it reaches 
the ears. To fuss over the tympanum after you have 
neglected the throat is literally "to keep the promise 
to our ear, and break it to our hope" — to try to put 
out the fire after it has reached the powder magazine. 
The chief warning to remember in treating and getting 
rid of colds and catarrhs is that " all roads lead to " — 
the ear, especially in the later stages of the attack; that 
every little influenza germ, whose motto is Excelsior! 
climbs the Eustachian tube to the ear, and that every 
effort on the part of the invader to reach "the man 
higher up" lands him on the eardrum. Take care of 
the nose and the ear will take care of itself. 

It is curious what picturesquely distorted notions 
prevail about the causation of even such common and 



HOW WE GROW DEAF 267 

frequent misfortunes as deafness and blindness. Both 
have formed "high lights" in the classic picture of old 
age since the very dawn of history. The explanation 
was as simple as it was plausible and poetic. The dull 
hearing and dimming vision were due merely to the 
gradual wearing away and blunting of the keen edge of 
all the senses and powers of the body under the success- 
ive shocks of years and the wear and tear of life. 

The auditory nerve was supposed to have been ham- 
mered and pounded, as it were, into a sort of stupor — 
the retina dazzled and flashed into a dazed condition 
where it could no longer respond to the rays of light. 
Deafness and the clouded vision of the old man were 
merely a part of the general scheme of decay — "sans 
hair, sans teeth, sans everything." 

Nothing could sound more reasonable and altogether 
in accordance with what was to be expected. So long 
as we were satisfied to accept statements of how things 
were ordained to be, or inevitably must be, instead of 
taking the trouble to find out what they actually were, 
this was a perfectly good explanation, and it has been 
embalmed in the literature of all the ages; but, the 
moment we began to ask uncomfortable questions and 
to insist on finding out the facts, a totally different 
condition of affairs was discovered to exist. 

Barely half a century ago, for instance, it was found 
that two thirds of the failing vision of old age was due 
not to any dulling of the retina or optic nerve, or dim- 
ming of the transparent parts of the eye, but merely to 
the failure of the little circular muscle within the eye- 
ball; so that the eye could no longer adjust or accom- 



268 COMMON DISEASES 

modate itself to the light rays. Practically perfect 
vision, keen and sharp, though, of course, more readily 
tiring than before, could be restored by fitting the 
proper "specs" — that is, placing a glass or a lens be- 
fore the eye to make good the failure of this muscle to 
act. 

Half the remainder of the blurred vision of advanc- 
ing years was found to be due to changes in the lens of 
the eye, known as cataract; and when the clouded lens 
was removed by a simple surgical operation, and a new 
clear lens of glass hung in front of the eye in its place, 
the retina was found to be as clear and sharp as ever. 
In short, the retina and the optic nerve of the old man 
of seventy were found to be practically as keen and as 
responsive to the light as they had been at seventeen; 
and a full third of the discomforts of old age were 
relieved at a stroke. 

The same thing has been found in regard to the dull 
ear of old age in even higher degree. Not more than a 
fraction of a per cent of the deafness of old age is due 
to changes in the nerve of hearing. In other words, the 
hearing of the grandfather is at bottom as keen as that 
of his grandchild if only the sound waves can actually 
reach the keyboard of his nerve. In the economic jar- 
gon of the day, it is the "middleman" who is at fault 
— the conducting apparatus that lies between the 
sound waves and the organ of hearing, known from 
that fact as the middle ear — that is really deaf. Nine 
times out of ten, when you say a man is deaf you mean 
that his eardrum and its piano-hammer attachments 
are out of order. 



HOW WE GROW DEAF 269 

Our hearing machine, though distressingly compli- 
cated in its details, is exceedingly simple in principle. 
Briefly, it consists of three parts, with a safety-valve 
attachment to one of them, known simply from their 
positions as the outer or external ear, the middle ear, 
and the internal ear. The safety valve is the joker that 
gives rise to nearly all the trouble. The division of 
labor between these three parts is matter-of-fact and 
rational. 

The outer ear, as plainly follows from its position 
and shape, is merely a horn or funnel for catching the 
sound waves and conveying them into the interior of 
the head, where the middle ear lies warm, sheltered, and 
out of harm's way. The outer ear is really of the most 
trifling importance — little more than a hole leading 
down to the drum, with a more or less movable flap 
over its opening. The sole value of the flap to-day is 
as an ornament — and it is not exactly a howling 
success at that in some of us. 

The middle ear is, in principle, equally simple and 
matter-of-fact. It consists merely of a tightly stretched 
disk or drum of skin, with a cavity in the bone behind it 
to allow it to vibrate. Across this cavity runs a chain 
of exceedingly delicate little bones which transmit the 
vibrations to the internal ear or organ of hearing 
proper. 

This internal ear is vastly more complicated; but, as 
it luckily seldom becomes diseased — and when it does 
we do not know what under Heaven to do for it and 
have no remedy that will reach it — its makeup is 
of little practical importance. We may here dismiss it 



270 COMMON DISEASES 

with the statement that it consists of a singular little 
keyboard about an inch and a quarter long, coiled up 
like a snail shell — cochlea — made up of tiny rods laid 
side by side, not unlike the keys of a pianoforte. 

The delicacy and elaborate perfection of the whole 
may be gathered from the fact that in its inch-and-a- 
quarter length there are five thousand separate rods or 
keys. Each of these keys is believed — though this is 
largely hypothesis — to vibrate in response to some 
tone or shade of tone that can be heard by the human 
ear; and their vibrations are conducted to the tiny 
twigs of the auditory nerve, which run along the under 
side of the keyboard and then unite into a small twisted 
cable, to pass to the brain. 

Each key is supposed to pick out its particular note 
by vibrating in response to it, much as the receiving 
apparatus of a wireless telegraph responds to or catches 
the particular vibration to which it is tuned. It is 
probable, between us, that here is the site of those ex- 
traordinary differences in tone perception ranging from 
the born musical ear, with its delicate appreciation 
of the subtlest harmonies, down to inability to distin- 
guish Old Hundred from Yankee Doodle. 

Not a little of the painful and laborious process 
known as "musical training" — laborious for the pupil 
and painful for the neighbors — consists in limbering 
up and drilling the keys of this internal piano. They 
are taught to work separately from one another, so 
that the slightest deviation in tone, known as flatting 
or sharping, can be accurately distinguished; and also 
they may be given such simple and rudimentary train- 






HOW WE GROW DEAF 271 

ing in arithmetic as will enable them to recognize when 
any note is struck which has two, three, or five times 
the number of vibrations of their own particular note, 
and to respond promptly thereto. This response to 
simple multiples or vulgar fractions of their own tone 
forms the basis of what we call harmony. In that last 
survival of the torture chamber of the Middle Ages — 
five-finger exercises — you are training not merely 
your stiff and unwilling fingers but the keys of this 
piano — a piano whose keyboard is coiled in your own 
head, or should be; but which often, so far as possi- 
bility of effective training is concerned, exists only — 
in the vernacular of the day — "in your mind." 

The three parts of the hearing machine will thus be 
seen roughly to correspond to the parts of the trans- 
mitter of a telephone. The projecting mouthpiece is 
the external ear and the hole leading down to the drum; 
the diaphragm is the drum, and the little chain of bones 
behind it is the armature which changes the vibrations 
of the diaphragm into alternating electric currents; 
and the auditory nerve is the wire that transmits the 
message to "central." 

It is well to have this general idea of the gearing of 
our hearing machine, both because the three divisions 
of it play widely different parts in the production of 
deafness, and also because the practical importance of 
the parts they play could almost be inferred from their 
position. 

The outer ear, being little more than a hole through 
which the sound waves can reach the drum in its place 
of shelter and safety an inch and a quarter below the 



272 COMMON DISEASES 

surface of the head, plays almost no part at all in the 
production of deafness; in fact, the only way in which 
disturbances of this part of the ear could interfere with 
hearing would be by blocking or plugging it up com- 
pletely — which, in the nature of the case, very seldom 
happens. Only two such accidents are known — tu- 
mors and accumulations of wax. 

The other end of the apparatus — the internal ear 
— is so deeply imbedded and buried within the bones 
of the head, so completely protected from all possibil- 
ity of exposure to attack, that it is literally one of the 
"safest" structures in the body; in fact, the only dan- 
gerous enemies of the keyboard and auditory nerve 
are the toxins of a few infectious diseases, which have a 
special power of singling out and attacking the brain 
and nervous system. For practical purposes, these may 
be reduced to two — one fortunately rare, the other 
more common — cerebro-spinal meningitis and blood 
taint. Could these two diseases be wiped out — and 
they are both preventable and one day will be pre- 
vented when we become intelligent enough — we 
should practically get rid of all deafness due to diseases 
of the keyboard and nerve of hearing, known as nerve 
deafness. 

This leaves the middle ear, or drum cavity and its 
attachments, as the weak link in our chain of hearing, 
the region in which nearly nine tenths of all cases and 
forms of deafness occur. The particular Ethiopian in 
our middle-ear woodpile, however, is that wretched 
little tube connecting the drum cavity with the throat, 
called the Eustachian tube, after the fine old father of 



HOW WE GROW DEAF 273 

anatomy who first discovered and described it. It 
might almost be called the deafness tube, for it is liter- 
ally the leak that lets in the flood — the underground 
passage through which our germ enemies can crawl 
and worm their way into the very citadel of our fortress 
of hearing. Then, once they have effected an entrance, 
they block up the passage that admitted them and 
proceed to be fruitful and multiply, torturing the de- 
fenseless drum and the delicate lining of the drum 
cavity until they weep literal tears of agonized exuda- 
tion and pus, thus raising the pressure in that tiny 
prison, until every little nerve twig in it, trapped and 
jammed against its bony walls, shrieks in agony. Then 
we say that we have an attack of earache. 

If the enemy be sufficiently numerous and vicious 
the tension will continue to rise in the drum cavity, and 
the pain will become more excruciating until the bacil- 
lus bomb literally explodes, either by rupture through 
the drum and discharging a gush of "matter" from the 
outer ear, or by blowing out the debris with which it 
had obstructed the Eustachian tube behind itself and 
pouring back harmlessly into the throat. 

Though this is the most painful and furious form of 
attack upon the middle ear, it is neither the common- 
est nor the most dangerous. Contrary to popular im- 
pression, bursting or perforation of the drum is not a 
dangerous accident, nor is it often followed by perma- 
nent deafness or even serious dulling of hearing. Every 
time there is a discharge from the ear in childhood 
this process has occurred; yet, as every one knows, not 
more than one case in fifty of "running from the ear" 



274 COMMON DISEASES 

is followed by permanent deafness. Instead of its being 
difficult to heal up the opening in the drum, our great- 
est trouble is to keep it open long enough to allow 
complete emptying of the cavity and clearing up of 
the inflammation within. Just as soon as the discharge 
ceases, the hole in the drum heals up completely, 
leaving only a slight scar, and the hearing quickly be- 
comes as good as ever. A puncture of the drum will 
heal as readily as a cut or scratch on the skin and leave 
no discoverable scar. So there is no need to fear deaf- 
ness for life because there has been an explosive or a 
"relief" perforation of the drum. 

This is not by any means to say that rupture of the 
eardrum is a mere trifle. It is anything but that. The 
hole made may be large and ragged enough to leave 
the drum permanently distorted and tied down by the 
scar, so that it will never vibrate properly afterward. 
Moreover, on account of the fact that the drum cavity 
is separated from the brain by only the thinnest plate 
of bone, the inflammation may push inward, so to 
speak, instead of bursting outward, and cause a serious 
meningitis or brain abscess; or the inflammation may 
spread to certain cavities in the skull just behind 
the ear — known as the mastoid cells, and set up the 
now famous mastoid abscess, which also threatens the 
brain. So that the only safe thing to do in cases of 
severe earache, whenever the inflammation has gone 
above a certain height and refuses to yield within a few 
hours to warm douchings and other local treatment of 
that sort, is to call in the ear specialist and puncture 
the drum with a delicate knife-pointed needle, so as to 



HOW WE GROW DEAF 275 

allow the matter or pus to escape harmlessly into the 
outer ear. 

Pus in the drum cavity is literally between the layers 
of the bones of the skull and may leak upward or in- 
ward into the brain or backward into the mastoid quite 
readily. Usually it works into the large spongy cavity 
in the mastoid — the bump behind the ear, phrenologi- 
cally known as "the bump of destructiveness " — and 
there gathers force for its attack on the brain. So that 
the moment the bump behind the ear begins to swell 
or redden, or become tender to pressure, it is time to 
call a surgeon. Then trephining or chiseling down 
through the bone to the hollow where the pus is will let 
it out and save the brain from attack. This is a serious 
operation, but better than a brain abscess. 

The middle-ear attack, which most commonly leads 
to deafness, is the one which produces little more than 
that sensation of fullness in the ears and woodenness 
or dullness in the head, which so frequently follows an 
attack of sore throat or influenza. Here the germs are 
fewer in number or less vicious in temper, and do not 
make themselves so disagreeable as to stir up an inflam- 
matory revolt of sufficient violence to "fire them out" 
bodily. They succeed in establishing either a perma- 
nent foothold or in setting up a slow, thickening, 
fibrous inflammation of the drum and of the mucous 
membrane covering the tiny chain of bones. 

The temporary excitement which their first arrival 
caused subsides. The dull, stuffed feeling in your ears 
disappears after a few days or perhaps a week or two. 
You think you are as well again as ever; but if you were 



276 COMMON DISEASES 

to test yourself with a watch or tuning fork, you would 
find you had lost a couple of inches of the distance at 
which you could hear it. Another cold is caught a few 
months or years later and fresh reinforcements are 
added to the hostile forces at work in your drum cavity. 
A sharper attack of stuffiness and temporary deafness 
follows; and when that subsides you have again lost a 
few more inches of your range of hearing. And so you 
slip gradually down the incline toward the pit of deaf- 
ness; until finally, by the fifth, tenth, or fifteenth at- 
tack, you have lost enough of the "margin" of your 
hearing to begin to make it difficult for you to hear 
ordinary conversation. Then you suddenly discover 
and announce to your friends that you must be grow- 
ing deaf. 

Then it is too late to do much more than save such 
hearing as you possess and stop the process from going 
farther. 

Just avoid common colds as completely as you pos- 
sibly can; attack them vigorously, with the assistance 
of the best expert advice that you can secure whenever 
they do occur. Be particularly careful that they are 
cleared up as promptly and as cleanly as possible, and 
not allowed to hang on for weeks or months at a stretch. 
Consult your family physician or a competent nose- 
and-throat doctor whenever any stuffiness in the ears 
or dullness of hearing lasts for more than three days, 
and you will escape at least two thirds of all your risks 
of becoming deaf, no matter to what age you may live. 
The main reason why deafness is so much more com- 
mon in later life than it is in childhood or young life 



HOW WE GROW DEAF 277 

is that there have been so many more years to catch 
colds in. 

Almost any infection that begins in or involves the 
nose and throat may also climb the Eustachian tube 
and attack the drum. Measles and whooping-cough, 
for instance, quite frequently do so, and pneumonia 
and the more violent types of epidemic influenza less 
frequently but with a peculiar deadliness, producing 
furious earache, with almost certain perforation of the 
drum and great danger of spreading to the mastoid. 

There is one infectious disease, however, that seems 
to have a special fondness for attacking the eardrum — 
so much so that it is probably the commonest single 
cause of chronic running from the ear — and that is 
scarlet fever; in fact, the two most important points to 
watch during the attack of this scourge of childhood 
are the ear in the first week of the fever and the kid- 
neys in the later stages. Fortunately the same method 
will tend to prevent ear trouble in all these fevers — 
namely, thorough and careful antiseptic treatment of 
the nose and throat by means of sprays and washes 
such as are advised in the treatment of an ordinary 
cold, only somewhat more strongly antiseptic or 
germicidal. Care in this respect will reduce the risks of 
ear trouble, even in scarlet fever, to a minimum. 

It is always well for the intelligent mother to be 
carefully on the lookout for earache in all the little 
fevers of childhood, including colds and tonsillitis, 
especially in children who are too young to tell or even 
clearly indicate with their little hands where the pain 
is situated. Successive attacks of loud and prolonged 



278 COMMON DISEASES 

crying or screaming without ascertainable cause in a 
baby or young child that is feverish, particularly if the 
little one rubs the side of its head or burrows its head 
deeply and restlessly into the pillow, should abrays 
rouse suspicion of earache and call for expert advice. 

Though colds or sore throats will cause earache or 
middle-ear disease in the adult directly, in children 
they more commonly do so indirectly by setting up 
that inflamed and suppurating condition of the roof 
of the throat now famous as adenoids. An adenoid 
child, with this pile of tinder at the very mouth of his 
Eustachian tube ready to flare up at the slightest spark 
of cold or chill, lives perpetually upon the brink of 
deafness. 

As a matter of bitter practical experience, most 
children with adenoids sooner or later become deaf 
enough to interfere with their studies and mental de- 
velopment; and the habit of attacks of earache after 
every slight cold in a child almost invariably means the 
presence of adenoids. 

Colds upon colds thicken up the drum and stiffen its 
conducting chain of tiny bones just as the proverbial 
dropping of water wears away the stone. The best pre- 
ventive of deafness is fresh air — twenty-four hours 
out of the twenty -four. For ninety-nine per cent of us, 
the statement, "no colds, no deafness," would be 
literally true. 

Of course the more completely we can avoid colds, 
the better it will be, not merely for our ears but also for 
our joints, our hearts, our kidneys, our livers, and our 
nervous systems; for the conviction is steadily growing 



HOW WE GROW DEAF 279 

that these puny "little foxes" in the body vineyard, 
these mere rats and mice in the House of Life, probably 
cause more Bright's disease, organic heart disease, 
gout, rheumatism, and neuritis than any other single 
influence. 

Though this "counsel of perfection," of absolute 
avoidance, is impracticable in the present state of our 
intelligence and the health conscience of the commun- 
ity, fortunately the very same measures which reduce 
the risks of cold-catching to the lowest possible mini- 
mum are also those that will enable us to acquire im- 
munity from colds, resist them vigorously when they 
do occur, and throw them off cleanly and promptly. 
So that if we live cleanly, wholesomely, happily, with a 
gentle current of fresh, cool air — popularly known as a 
draft — blowing across our faces two thirds of the 
time — day and night — with plenty of exercise in the 
open air, plenty of rich and appetizing food and plenty 
of sleep, we can practically snap our fingers at colds 
and ninety-nine per cent of their deadly consequences, 
including deafness. 

Our noses and throats are evidently, under civiliz- 
ation at least, points of least resistance in the body. 
This is illustrated by the fact that they are not only 
the site of the commonest of all our diseases — colds 
and their relatives — but are also the port of entry for 
at least half, if not two thirds, of our more serious in- 
fections, such as measles, scarlet fever, smallpox, 
diphtheria, and so on. It is a useful and practical pro- 
cedure to keep in your bathroom or your bedroom, or 
on a shelf of your medicine chest, some form of mild 



280 COMMON DISEASES 

alkaline and antiseptic nasal spray or wash. Your 
family physician will gladly give you a prescription for 
one suited to the special conditions of your nose and 
throat, or the "family" nose and throat. Then use the 
wash whenever you suspect that you have been exposed 
to risk of infection by a common cold — for instance, 
when you have been to the theatre or to church, or in a 
crowded, stuffy, smelly train or street car — or when- 
ever you feel any sensation of tickling, dryness, or 
stuffiness in the nose and throat, and with redoubled 
vigor when you think you are catching cold. I know of 
no "stitch in time" in our hygienic economy that is 
more likely to "save nine" than this simple procedure. 
The chief things needed in these washes are that 
they should be as nearly as possible of the same density 
— specific gravity — and temperature as the blood, 
and not too strongly antiseptic; for it is almost im- 
possible to make them strong enough to kill or even 
seriously injure the germs in the nostrils without mak- 
ing them injurious to the delicate membrane of the 
nose. If properly adjusted to individual conditions 
they are perfectly harmless and have a decided effect 
in diminishing the probability of colds being caught, 
the severity of their attack if they do occur, and the 
likelihood of their hanging on or producing unpleasant 
after-effects. Then, in the event of a definite impair- 
ment of hearing which does not promptly subside 
within two or three days, consult your family physi- 
cian or a nose-and- throat specialist. Nothing is easier 
than to cure deafness at this stage of the process; and 
even a single treatment now may be the means of 



HOW WE GROW DEAF 281 

blocking the way in the direction of serious and per- 
manent hardness of hearing. 

It may perhaps excite wonder in some minds as to 
why that wretched little rift in the lute, that fatal leak 
in the side of our bark of hearing — the Eustachian 
tube — was introduced or permitted in our bodily 
makeup by Nature. In view of its dangerousness, why 
should we not stitch or plug it up completely in some 
way and thus protect the middle ear from a thousand 
risks? Unfortunately it is as necessary as it is danger- 
ous. If our eardrum is to vibrate at all it must have air 
on both sides of it, and the pressure of the air inside or 
behind it must be kept equal to that on its outer sur- 
face; and this tube is simply an equalizing pipe for that 
purpose, through which air can be sucked into the 
drum cavity whenever a vacuum begins to form. 

Indeed, blocking up the tube alone will cause deaf- 
ness. The air in the drum cavity is quickly absorbed 
into the blood, producing a partial vacuum; and then 
the atmospheric pressure of the outside air upon the 
drum pushes it in, so that it can no longer vibrate ; and 
at the same time it jams the little chain of bones to- 
gether so tightly that they cannot transmit the sounds. 
This is one of the methods by which middle-ear deaf- 
ness is produced — the tube becomes blocked by in- 
flammation, the drum is driven in by the pressure of the 
outside air, and slow fibrous changes tie it down and 
glue the bones together — and permanently fix them 
so. This is why the mere driving out of a bubble of air 
along the Eustachian tube — as, for instance, when 
you blow your nose and your ear "goes pop" — will 



282 COMMON DISEASES 

sometimes improve your hearing when your head is 
stuffed up and your ears feel blocked and full. 

However, every cloud has its silver lining — and 
deafness is no exception. In spite of the swarms upon 
swarms of enemies that threaten the peace of our ear- 
drums, and the frequency of some degree of hardness 
of hearing after middle life, there are two or three con- 
soling items to be entered on the credit side of the 
ledger. The first of these is that, as we have already 
seen, all these conditions are not only preventable but 
in process of prevention by the spread of intelligence 
and the progress of sanitary science. The second is 
that the vast majority of cases of deafness, even after 
they have got a good start, can be kept from develop- 
ing beyond the stage where there is still sufficient 
hearing left for most practical purposes. And, last and 
most fundamental of all, middle-ear disease, which 
causes nine tenths of all deafness, almost never com- 
pletely destroys hearing. 

This last is inherent in the nature of the affection; 
for, as we have seen, the middle ear consists entirely of 
conduction apparatus, and the real, live, essential parts 
of the organ of hearing — the nerve and the sound- 
keyboard — are absolutely untouched and as perfect 
as ever. So that, if we can only get sound waves to 
reach the internal ear by some hook or crook, it can 
still hear them. The easiest and, so to speak, the most 
open route for sound waves to reach the nerve of hear- 
ing is, of course, through the ear canal, the drum and 
its bones; but luckily this is not the only channel. 

Just as soon as sound waves are loud enough to jar 



HOW WE GROW DEAF 283 

through the bones of the head, they can reach the 
nerve of hearing and be heard, though the ear be com- 
pletely blocked. Upon this fact depends the usefulness 
— unfortunately not very great — of the various 
trumpets, tubes, and fanshaped hearing instruments. 
Some of these are pressed into the ear; some rest upon 
the upper front teeth if these be still our own; but 
all such appliances help chiefly by virtue of the fact 
that they collect sound waves and communicate them 
directly to the bones of the head and through them to 
the nerve of hearing. 

The ear trumpet assists the hearing partly by the 
size of its mouthpiece or bell, which collects the sound 
waves and somewhat magnifies them, and partly by 
its pressure on the ear which brings the instrument 
into direct contact with the bones of the head. The 
speaking tube is more effective yet, because the lips of 
the speaker are held so close to its mouthpiece that the 
vibrations of his voice are communicated directly to 
the walls of the tube and carried by them to the bones 
of the deaf person's head and thus to his nerve key- 
board. 

It is impossible to say even approximately how fre- 
quent deafness is in the community — partly for the 
reason we have just been considering, that so few cases 
ever reach the extreme or disabling stage, and partly 
from the fact that Nature with her wise and kindly 
foresight has provided us in advance with nearly three 
times as much hearing as we actually need for ordinary 
purposes. It is a matter of common observation in the 
consulting room, or in the clinic at the ear hospital, 



284 COMMON DISEASES 

when patients come in complaining that they think 
they are "beginnin' to get hard of hearin'," that they 
have usually lost from one half to two thirds of their 
normal hearing. They can barely count the ticking of 
a watch at eight or ten inches, for instance, which they 
should hear at forty inches. 

There is this consolation, however, that, if we can 
succeed in improving the condition of their drums up 
to where they can hear the watch at fifteen inches, they 
have regained all the hearing they need for practical 
purposes and will consider themselves cured. This 
margin gives us a valuable means of warning in ad- 
vance; and if any one over forty has the slightest doubt 
or suspicion about his hearing it is not a bad idea for 
him to test it occasionally by the simple process of try- 
ing how far away he can hear his own watch tick, 
which usually should be about thirty to forty inches. 

If a systematic test were to be made of, say, a thou- 
sand persons of fifty years of age and upward, it would 
probably be found that most of them had lost some of 
the surplus or keener edge of their hearing ; but very few 
of them would probably ever have recognized the fact. 
Those who had lost enough of their margin of hearing 
to make it obvious, either to themselves or to their 
families, that they were becoming deaf would only be a 
moderate-sized group; and, even of these, probably not 
more than one in ten would have lost enough hearing 
to make it a matter of grave inconvenience or even 
serious annoyance to them, while not more than one 
or two in the thousand would have become "stone" 
deaf. So, though the outlook for complete cure of one 



HOW WE GROW DEAF 285 

who has begun to grow noticeably deaf is not encour- 
aging, the prospects of his being spared the graver and 
more disabling degrees of loss of hearing are very good. 

Though little need be said about the forms of deaf- 
ness due to disease of the two extremes of the hearing 
apparatus — the external and the internal ear — yet 
there are a few facts of practical importance about 
both. First and briefest, the almost sole condition of 
the outer ear which seriously interferes with hearing is 
wax. This curious, half-oily, half-gummy substance is 
the natural secretion poured out by glands in the skin 
of the outer ear, which resemble the sweat-glands over 
the remainder of the body. The secretion's use is, 
first, to keep the skin properly lubricated, supple, and 
waterproof; and, second, by its gradual outward flow 
to carry out of the ear canal and deposit in the bell of 
the outer ear such dust, lint, bacteria, and even tiny 
insects, as may have been blown into the canal. A 
considerable amount of wax in the canal of the ear is 
absolutely necessary for its health and safety, and the 
main thing to remember is that the wax is to be strictly 
and absolutely let alone until it has flowed out into 
the hollow of the outer ear, where it can be wiped away 
with a cloth over the tip of the finger in the ordinary 
toilet of the face and neck. 

It is not until the flow of the wax becomes checked in 
some way and begins to dry and pile up in large masses 
in the ear canal that it causes any trouble whatever 
with the hearing. 

The two most common causes of this damming up of 
the wax are: first, middle-ear disease, which in some 



280 COMMON DISEASES 

curious way appears to alter the chemical character of 
the secretion of wax in the outer ear; second, meddle- 
some interference with the normal and necessary 
amount of wax in the ear under mistaken notions of 
cleanliness, such as endeavoring to scoop it out with 
the twisted-up corner of a towel, or even with one of 
those inventions of the Evil One, the earspoon or ear- 
pick. The homely advice of the old German proverb 
is thoroughly sound and reliable: "Never clean your 
ear with anything smaller than your elbow." 

The proper method of removing wax is simplicity 
itself — gentle syringing with plenty of warm water 
through a syringe with a long and properly curved 
nozzle; but this should never be undertaken by any 
one but a physician, as the damage that may easily be 
done to the delicate tissues of the drum is far greater 
than any that will result from leaving even the largest 
plug of wax in place. The actual plugging effect of wax 
in producing deafness is very much less than was for- 
merly supposed as, unfortunately, when the physician 
has syringed out every particle of wax from the ear 
he often finds a thickened and distorted drum behind 
it, which was causing two thirds of the hardness of 
hearing. 

We may relieve our minds of one dread of the future. 
Not only is the nerve of hearing exceedingly well pro- 
tected against disease or injury but it is astonishingly 
enduring and tough and fatigue-proof in its own proper 
business, so to speak — that of receiving and respond- 
ing to the sound waves. Not even the horrible racket 
and cacophonous noises of modern civilization can in- 



HOW WE GROW DEAF 287 

jure it in the slightest degree; and there is no danger 
of our being deafened, except momentarily and meta- 
phorically, by the whole Wagnerian overture of city 
life, with all its accompanying clanging and shrieking, 
rattling and roaring, hammerings and explosions. 

Legend and fiction to the contrary notwithstanding, 
there is no authentic instance on record of deafness 
produced by noise, no matter how loud or how madden- 
ingly incessant. The only apparent exception is that 
the discharge of a cannon or an explosion of dynamite 
may rupture an eardrum; but this is simply due to the 
direct violence of the explosion and has nothing di- 
rectly to do with the noise of it. Like other ruptures of 
the drum, recovery is usual; and such impairment of 
hearing as may result is due to the damaged condition 
of the drum. 

The most citified civilized man, provided he has 
escaped middle-ear inflammation, has just as keen a 
sense of hearing as the freest and wildest savage, the 
only difference being that the civilized man does not 
know how to interpret every faintest whisper and 
sound as does the Indian hunter, for instance. Even an 
engineer could beat an Indian in delicacy of hearing, 
when listening to discover whether his engine was run- 
ning properly at every point. 



CHAPTER XIV 



FOOT FAULTS 



ONE of the best foundations for success in life is 
a good pair of feet. No small proportion of our 
efficiency and our comfort depends upon our ability to 
"make tracks" with agility, precision and persistence. 
And that ability is very closely related to the shape of 
the tracks that we make. Well doth the good Book 
admonish to take heed unto our feet, and next to tak- 
ing heed of the direction in which we point them comes 
care of the shape in which we keep them. I said 
"keep" intentionally, for Nature made them right in 
the first place if we will only be careful not to spoil her 
results. 

There's a tremendous lot of responsibility on feet. 
No matter how big and bulgy a brain a man may have, 
it 's his poor tired feet that have to carry it around for 
him, and some brains I know would make any pair of 
feet tired — the weight of them, I mean. We hear a 
great deal of late years, particularly, about heart fail- 
ure as a cause of breakdown, but as a matter of fact 
"foot failure" is far more common and wellnigh as 
important, though of course not so fatal or dramatic. 
No man is stronger than his flattest foot. Certainly two 
thirds of our backaches, a fair share of our headaches, 
a large moiety of the pains and penalties supposed to 
be a peculiar heritage of women, are due solely to bad 



FOOT FAULTS 289 

shoes and sins against our feet. We have all heard of 
and laughed consumedly at the imaginary individual 
who was so short that when he had a pain he could n't 
tell whether it was headache or corns, but there is 
many a six-footer who is in just such a predicament, 
The unbalance caused by badly shod or painful feet 
is not only fundamental but most far reaching, and 
myriad as are the breakdowns and cripplings in other 
parts of the body produced directly by it, there are 
many more in which it plays a weighty contributing 
part. Corns and bunions and flat feet are not only 
painful and disfiguring and disgraceful — they and 
their like are the real pudenda, parts of our bodily 
structure that we ought to be ashamed of, not anything 
created by nature — but they are also a very serious 
handicap upon our efficiency in every direction, mental 
as well as physical, and moral more so than either, 
reducing our H.P. at least fifteen or twenty per cent. 
A man with tight boots and corns may get to heaven, 
but it will only be because the recording angel is deaf or 
takes a day off from his job occasionally; while he that 
hath no comfort in his feet is far more essentially fit for 
treasons, stratagems, and spoils than the blameless man 
who happens to be tone deaf, in other words, "hath no 
music in his soul." If Csesar really wished to have good- 
natured people about him he would have been far more 
sensible to have paid attention to the opposite pole of 
the body and to have picked out instead of "sleek- 
headed men and such as sleep o' nights," smooth- 
footed men whose shoes are never tight. 

Misery loves company, and it may be some slight 



290 COMMON DISEASES 

consolation to us to know that we are not the only ani- 
mal that breaks down foremost and frequently in his 
feet. Our friend and servant, the horse, has even more 
trouble with his feet than we have with ours, and for 
something the same reason, namely, over-specializa- 
tion. For while he still has all his weight-bearing and 
work distributed among four feet instead of concen- 
trated upon two, yet in the interests of speed and 
specialization his feet have had not merely their 
heels but the soles and the balls pulled up from 
the ground and the toes whittled off one after another 
on each side until finally he is reduced to support- 
ing his entire weight upon the thickened toenails of 
his middle fingers. Toenails are wondrous tough, but 
they have their limitations; and while Equus cabal- 
lus got along all right as long as he roamed at 
large over the plains with flying mane and crimson 
nostril, road trotting, and particularly street hauling, 
are another pair of shoes altogether. As Leech's 
groom expressed it many years ago, " Oh, it ain't the 
'unting across the 'edges and ditches after the 'ounds 
that 'urts 'im, it 's the 'ammer, 'ammer, 'ammer on the 
'ard 'ighroad." And it does " 'urt 'im" terribly, for as 
any experienced horseman or veterinarian will tell you, 
not only is unsoundness in the feet overwhelmingly the 
chief cause of disability, loss of value, and aging in 
horses, but that all so-called broken knees, most 
sprung shoulders, weak backs, so-called kidney trou- 
bles and lamings 01 every description are due to in- 
flammations of the hoofs. Roughly speaking, as long 
as a horse's feet are good, he's good. 



FOOT FAULTS 291 

In one of those dreadful, gasping hot spells, which 
we occasionally have in New York in summer, I was 
walking down the Sixth Avenue, when my attention 
was called to the frightful discomfort and distress 
among the poor horses by seeing one of them fall, as if 
he had been shot, from sunstroke. Within less than a 
mile I saw two other poor beasts who had just been 
helped to their feet after a similar experience, and hap- 
pening to notice that the first one of these stood upon 
three feet and toed over and fidgeted upon the other 
one in such way as to show clearly that he was lame 
in it, I took pains to notice the other horses as I passed 
down the street whose drenched coats and drooping 
heads and panting nostrils showed clearly that they 
were in distress, and every one of them had either 
broken knees or stood on three feet, or fidgeted from 
one foot to another as if all of his feet were sore; while 
the second poor brute that I saw recovering from sun- 
stroke could hardly stand on his feet after he had been 
helped up on to them, they were so sore and painful. 
If any human being wants to double his or her risk of 
sunstroke in hot weather, one of the surest and most 
effective methods of doing it is to cultivate a crop of 
corns and wear tight, crippling shoes. 

I worked the test both ways, part of the time looking 
first at the nostrils and coats of the horses and then at 
their feet, and part of the time at their feet first and 
then at their nostrils and coats, and the connection 
never failed. 

Not only did I never find a horse with lame feet 
who was not distressed, but I never found a horse with 



292 COMMON DISEASES 

perfectly sound feet who was seriously distressed, ex- 
cept a few who were overloaded or who had apparently 
been overdriven. 

Nevertheless sufficient unto the animal are the feet 
thereof in spite of all the stresses and strains to 
which they are subjected even under civilization, if 
they are just given a fair chance to adjust themselves 
and a decent show to do their new work in their own 
way. Indeed the parallel between ourselves and our 
equine cousins is very much more nearly a case of 
horse and horse than we might at first sight suppose. 
A very large share of the lamings of both the human 
foot and the horse's hoof are due not so much to actual 
overwork or overstrain, as to practically one and the 
same cause, namely, our utter and grievous lack of 
horse sense in surrounding both hoof and foot with a 
hard, rigid band of iron in the one case and leather 
in the other, which absolutely prevents its expansion 
when weight is thrown on it. The moment you do that 
you might just as well have pieces of two-by-four 
scantling under you instead of feet. The prevention of 
expansion works its damage in slightly different ways 
in the foot and in the hoof, but the general principle is 
the same and the net results distressingly similar. 

It may appear almost paradoxical to talk about ex-_ 
pansion in such a hard, stonelike structure as the hoof 
of a horse, "but she do move just the same," "e pur se 
muove" as Galileo remarked of the world, coming up 
the cellar stairs from the torture chamber of the In- 
quisition. A horse's hoof, rigid and solid as it looks, 
actually does get slightly but appreciably bigger every 



FOOT FAULTS 293 

time he steps on it, and the prevention of this expan- 
sion, even if it be only a fraction of a fraction of an 
inch, by an unyielding iron shoe will make all the differ- 
ence in a few weeks or months between soundness and 
hopeless and crippling lameness. 

The most deadly damage done by the horseshoe is, 
however, by preventing expansion of another sort, in- 
ternal expansion we might call it. The point on which 
a horse's weight should naturally be supported and the 
one which strikes the ground first when he walks or 
trots is not the hard, toenail-like rim of the hoof but 
the thick, spongy pad in the centre of the foot, half 
leather, half rubberlike, known as the frog. In a state 
of nature this thick, spongy pad projects well above, or 
rather, below, the hard rim of the hoof, which is simply 
used to push off with, which gives that beautiful cush- 
ioned deerlike gait to the bronco on the plains, or the 
unshod colt in the pasture. 

But the moment that man permanently enslaved 
the horse and began to use him on rocky roads or hard 
pavements, one of the first things that he did, with the 
usual intelligence of the master and employer class in 
dealing with the worker, was to protect his poor, un- 
shod feet by nailing bands of iron around their rim and 
providing these with calks or crossbars which lifted the 
softest and most defenseless-looking part of his foot, 
the frog, out of harm's way and prevented it from com- 
ing in contact with the ground at all. It took eight or 
ten centuries for them to discover that the apparently 
benevolent protection and assistance that they were 
giving to their faithful servant was really crippling him 



294 COMMON DISEASES 

for life, nearly as long in fact as it took human work 
horses to make the same discovery in regard to the 
benefits and benevolences conferred on them by the 
master class. 

Directly underneath the horny projection of the 
frog lies a big, elastic sponge of blood vessels; whenever 
the natural hoof strikes the ground the weight of the 
body falling upon the frog squeezes out the ounce or 
more of blood in this sponge and drives it into every 
part of the foot, and when the weight is taken off by 
the foot being lifted from the ground the sponge refills 
itself by its own elasticity and is all ready for another 
squeeze at the next step. In other words the frog is a 
sort of local heart for the nutrition of the foot. What 
wonder then that centuries before we took any trouble 
to know anything about the structure of the frog we 
found that the last and most hopeless act in the drama 
of laming was what was known as contracted heels or 
contracted hoof, a shrinking inward of the heel or rear 
corners of the toenail with general atrophy of the hoof. 
But once this has occurred the poor beast is fit for 
little more than the slow torture of the peddler's cart 
or the swifter and far more merciful exit of hide and 
bone factory. 

What has happened is simply that the foot, deprived 
of its natural rhythmic expansion, driving the blood into 
every remotest portion of it, and particularly around 
the rim of the toenail, is cut off from a fair half of its 
nourishment and begins to shrink and shrivel in a literal 
living decay. While we might perpetrate this stupid 
barbarity upon a horse's hoof, it would hardly seem 



FOOT FAULTS 295 

credible that we would be guilty of such painful stu- 
pidity towards our own feet; yet I grieve to state that 
I fear it would be well inside of the truth to say, that 
nearly fifty per cent of all living human beings and the 
more citified and so-called intelligent, the worse, are 
to-day suffering from contracted hoofs. 

We don't carry the atrocity quite so far, of course, 
in our own case, partly because we don't make shoes of 
iron and can't nail them on, and partly because after 
all they 're our own feet, and personal discomfort sets 
certain limits to even human vanity and stupidity. Al- 
though in the case of other people's feet, iron-bound 
and copper-toed clogs with wooden soles are highly 
recommended for wear by work people as helping 
them to live within their income upon the wages vouch- 
safed to them by various kindly and benevolent Manu- 
facturers' Associations of England and other parts of 
Europe. 

Incidentally it might be remarked that we have 
practically solved, or are solving, the problem of foot- 
wear for the horse, have in fact made a better begin- 
ning in that direction in providing ourselves with ra- 
tional footwear. Many of the most valuable horses, 
both draft and carriage, nowadays, are no longer 
shod with iron or metal of any sort but with discs of 
compressed rawhide skillfully fastened to the hoofs 
without nails. The shoes wear out quicker of course 
than iron ones, and this was the most obstinate objec- 
tion to their introduction ; but the hoofs underneath 
them wear a great deal longer, and fortunately a good 
horse is worth a great many pairs of shoes, though we 



296 COMMON DISEASES 

don't seem to have fully discovered this saving truth 
in regard to the human animal. In addition to the 
rawhide shoe the frog, instead of being lifted as high 
as possible, and even pared away for fear it would touch 
the ground, is covered with a thick, soft pad espe- 
cially prepared of elastic virgin rubber which restores in 
full its pumping action but protects it from bruising 
on stones or pavements. 

Even the horse has got his gum shoes on and is able 
to "rubber around." As a substitute for Puss in Boots 
we have the Horse in Gum Shoes. 

Our own ironbound footcasings cripple us more uni- 
versally than the horse's do him, though in a slightly 
different way. Their chief damage is effected by pre- 
venting the nearly three quarters of an inch length- 
ways expansion and half an inch crossways expansion 
required by the giving of its beautiful combination of 
arches. This reduces at once the beautifully elastic, 
graceful, and enduring gait to a stiff, rigid, clumping 
sort of stumble, or, at best, mincing strut which makes 
real walking a punishment. Whenever this gait has 
once been struck one thing may be counted on as cer- 
tain, and that is that such an individual will never 
willingly and consentingly walk to exceed half a mile 
a day, and will take most of his exercise with praise- 
worthy regularity running from the door to the street 
car and from the street car to the office elevator. If it 
were not for the acrobatic, strap-hanging stunts re- 
quired of them in the cars and in the subways — and 
their corns — New Yorkers would almost forget that 
they had such things as feet. 



FOOT FAULTS 297 

This spells the decline and decay of our understand- 
ings in two different ways. First, by making all walk- 
ing, beyond the merest tabbycat trottings about, out 
of the question, and thus weakening the tissues and 
arches of the feet, but even worse, the muscles of the 
calves, the legs, the hips and the back, indeed of the 
whole body, paving the way for that distressing and 
most crippling of foot faults, flat feet. 

The second way in which shoes spell damage is ex- 
actly parallel to the case of the horse. In fact a short, 
tight shoe is literally as well as metaphorically "a 
horse on us." Nothing living under heaven can thrive 
unless it has plenty of exercise, from teeth and brains 
clear down to toenails and feet. And when your feet 
are put in splints or strait-jackets for ten or twelve 
hours every day, it is not long until they begin to lose 
strength and vigor from the loss of the normal pump- 
ing action of their alternate expansion and contracting, 
and this lowers the nutrition of all their tissues and 
lays the foundations of corns and bunions upon the sur- 
face under the chafing pressure of the shoe, and of 
various other kinds of weak and painful and swollen 
feet. 

It also makes the circulation through them poor, so 
that their unfortunate possessor is perpetually suffer- 
ing from cold feet, which are even worse physically 
than they are metaphorically, rendering them un- 
able to resist accidental wettings and chillings from 
cold or snow or slush, which if they were big and elastic 
and hearty they would pay no attention to at all. 
This lays the foundation not merely for the famous 



298 COMMON DISEASES 

train of misfortunes, coughs, colds, and consumption, 
but also for congestion of the liver and stomach, and 
disturbances of the circulation in the joints and in 
the nerves, making the unfortunate cold-footer neu- 
ralgic and rheumatic and dyspeptic. 

We seldom fully realize to what an enormous extent 
anything that interferes with the free, vigorous, and 
enjoyable use of our legs lowers our entire vigor and 
impairs the whole condition of our health. The best 
lung developers ever invented are the muscles of our 
legs, and walking is not merely our best exercise, but, 
broadly considered, makes up fully three quarters of 
our total exercise, especially among city dwellers, ex- 
cept where the muscles of the hands and arms are 
vigorously employed in manual labor. If you cut 
off walking, or make that disagreeable, not to say 
painful, you cut off at one stroke from two thirds to 
three fourths of our possibilities of exercise in the 
open air. 

I happen to have had, at one time or another, for 
my sins, a good deal of experience in endeavoring to 
drive women, more particularly of the comfortably 
situated classes, to take even a decent apology for an 
adequate amount of exercise daily in the open air, and 
I have no hesitation in saying that three fourths of the 
almost insuperable difficulties encountered in such a 
crusade are due solely to their ridiculous and vile-fit- 
ting shoes. Part of the difficulty, of course, is due to 
the strait-jacket corset, and the binding, hobbling ef- 
fects of the skirt, but both of these again are closely 
related to and dependent upon bad shoes, for the pain- 



FOOT FAULTS 299 

ful, practical syllogism runs steadily. Bad shoes mean 
no walking, which means ugly feet, and "not to put 
too fine a point on it," as Mr. Toots would say, 
unbeautiful limbs. These again mean skirts of the 
thickest and longest; for the chief rock of defense 
which has protected that relic of barbarism, the 
skirt, from every form of attack by reason, health, 
and aesthetics for centuries, and will probably con- 
tinue to do so for centuries to come, is the plain, 
uncomplimentary, and humiliating fact that most 
women are ashamed of their feet and ankles because 
they think that they are not pretty, and candor 
compels me to admit that a good many of them are 
right. 

The worst and most seriously disabling of faults 
which lead to foot failure is flat foot. This distressing 
and sadly familiar condition of affairs is pretty de- 
finitely and graphically described by the name it 
bears. The arches of the foot, particularly the long- 
est one from before backward, have given way or 
broken down under pressure, thus depriving the gait 
of all elasticity and making even standing painful, 
partly from pressure upon the tender tissues in the 
instep of the foot, and partly by the grinding against 
one another of the bones of which the arch is com- 
posed. The acute pain which often accompanies flat 
foot seems to be due, in considerable measure, to 
the fact that the bones on which the arch of the foot 
is built are, like a good piece of stone masonry any- 
where else, made in wedge or keystone shape with 
their smaller ends pointing downward, so that the 



300 COMMON DISEASES 

more the arch is flattened, the more tightly the upper 
margins of the bones are jammed against one another 
and against the surrounding tendons and other tis- 
sues. In this jamming both small blood vessels and 
sensitive nerve twigs, which under normal conditions 
have plenty of room to run without pressure upon 
them, are stretched and pinched so as to give rise 
to intolerable discomfort. This may occur not merely 
between the bones of the arch of the instep, but also 
between the bones of the cross arch in the sole of 
the foot. Curiously enough it makes little difference 
what shape of shoes you wear after you have actually 
got flat foot; it was the shoe you were wearing three 
months or three years before that caused the break- 
down. 

As has already been outlined, bad shoes cause flat 
foot, chiefly by making walking disagreeable, and in 
this way weakening the muscles, not only of the foot 
itself, but also the legs above it, particularly those of 
the calf. The exact way in which the arch is let down 
is interesting and somewhat unexpected. It simply 
depends upon the anatomical fact, that while the arch 
of the foot is composed of a series of wedge-shaped 
bones carefully and neatly articulated together, these 
alone by their shape and bulk would never support 
the weight of the body for a moment, as is gruesomely 
illustrated by the fact that if a dead man be placed on 
his feet his arches flatten down at once. 

Such a gruesome probability as this may even have 
its uses, for there is an ancient historical legend abroad, 
widely circulated, and, as historical legends go, au- 



FOOT FAULTS 301 

thentic, — quite, if not more, for instance, than some 
of the myths about the Mayflower and her passengers 
— to the effect that various of the races of western 
Europe, notably the Picts and Scots of the North, 
had such enormous feet that they would remain 
standing upright even after they were dead. So that 
after the battle it was customary for the Roman 
victors to go around and give a vigorous push to all 
the enemy that remained standing on the field of 
battle to see whether they would fall or not. If they 
fell over they were presumed to be dead, and if they 
remained standing they were taken prisoners. 

The thing then which maintains the arch of the foot 
as an arch in the living body, is the constant pull and 
support of the muscles, muscles not in the foot itself, 
which contains comparatively little muscular struc- 
ture, but in the bulge of the calf of the leg above, from 
which origin tendons, or ropes of animal whipcord, run 
down into the foot, and running from before back- 
ward, from heel to toe, string up the longitudinal arch 
just as a bow-string strings a bow. While others of 
them, running down the inner side of the leg, turn under 
the arch of the instep and run completely across it to 
the outer side of the foot to attach to a bone near the 
base of the little toe, from which anchorage they guy 
or buoy up the crossways arch of the foot continually. 
Cut or weaken the muscles of the calf and down go 
both the arches of the foot, just as a bow relaxes 
when you cut its string. Indeed, extraordinary and 
sickeningly gruesome as it may sound to-day, the 
ancient Romans, with that fiendishly accurate know- 



302 COMMON DISEASES 

ledge of anatomy possessed by the wolf and the weasel, 
were actually in the habit of producing an artificial flat 
foot in their prisoners of war by the simple and effective 
method of a slash across the back of the calf as they 
overtook each unfortunate fleeing from the field of 
battle, thus ham-stringing him. In this pleasing man- 
ner they both effectually prevented his escape and 
made him a sure and safe slave or house-servant. 

One significant and hopeful fact there is about flat 
foot, nobody is born with it and children under ten 
or twelve comparatively rarely have it, unless they are 
sickly or half-starved. It is one of those accomplish- 
ments which we acquire ourselves or confer upon .our 
children. And as we literally make ourselves or our 
children flat-footed, it is obvious that we can prevent 
the condition by the exercise of a little foresight and 
common sense. All we need to do is to let children fol- 
low their unspoiled instincts, and run and dance and 
skip and play in the open air as much as they want to, 
and they will never get flat feet. Broadly considered, 
flat feet never grow outdoors. 

There are three main causes which produce flat foot 
in children or young adults. The first is tight shoes, 
the second is the schoolroom, and the third puritanic 
, notions about plain food being good for children. It is 
doubtful which is the commonest product of our pre- 
sent antediluvian system of education, dull brains or 
flat feet. We concentrate most of our effort in school 
upon the upper pole of the body, and this is fortunate 
because the brain is the toughest part of the child's 
body and a good deal of the pounding and overloading 



FOOT FAULTS 303 

directed to it bounces off as it were and hits the 
feet. 

Many an unfortunate youngster who has been stood 
up two hundred days each year under our educational 
pile-driver comes out of it in much the same condition 
as did the Alabama darky who was seen limping pain- 
fully along the street one day. When asked by a 
sympathizing friend what was the matter with him, he 
indignantly explained, "That thar Rastus Brown am 
the stupidest and most disconsiderate nigger I most 
neber saw. Him and me had a scrap 'bout somepin* 
yesterday and he up and lambasted me wid a piece of 
scantlin' right over the top of the head, when I was 
standin' on a cement sidewalk, and most busted my 
po'h feet to pieces. " 

The confinement and bad air of the schoolroom 
lower the tone of the entire body and weaken all the 
muscles, and the feet catch the strain. 

Next after confinement in the schoolroom, the most 
fruitful cause of flat feet is that group of occupations 
which involve a good deal of confinement indoors, 
and much standing or' moving slowly about without 
much opportunity for active walking, particularly if 
these be combined with bad air and poor food. The 
occupation in which all these evil factors meet their 
highest perfection and their most exquisitely effective 
combination furnishes the largest number of flat feet, 
and that is domestic service. 

Close after them, and not at all a bad second, come 
housewives who have to do their own work, especially 
where that work is excessive in amount, and the pro- 



304 COMMON DISEASES 

blem of making ends meet is solved by giving the best 
of the food to the husband and children, going half fed 
themselves; which pleasing conditions obtain in about 
forty per cent of the households of this favorite land. 

Next in this parade of pedal disaster come shopgirls 
and factory workers who have to stand the greater 
part of the time or do their work on their feet. Then 
come clerks and bookkeepers, who do their work 
standing at the .old-fashioned high desks, nurses in 
hospitals, and attendants of all sorts in hospitals, 
public buildings, etc. 

Almost the only outdoor classes who suffer markedly 
from flat foot are policemen, letter-carriers, and sol- 
diers. So serious and annoying a difficulty is this in 
policemen, that they have a special and rather graphic 
name of their own for it, namely, " cheese feet," by 
which is meant that the flattened and unelastic feet 
bump along and strike the ground as flatly as a pair 
of cheeses would. 

The reason why such a surprising amount of this 
defect of weaklings occurs among these classes, who are 
always picked men, are far above the average physique, 
and usually in good vigorous condition, is that their du- 
ties involve such an amount of foolish and abnormal 
standing or strutting about in constrained attitudes, in 
the case of policemen and soldiers, and in the case of 
the letter-carriers staggering along under such heavy 
burdens of mail awkwardly flung on one shoulder. 

In fact, we cannot too clearly bear in mind that man 
is not yet fully a biped, that is to say only for walking 
purposes; for standing purposes he is a triped and will 



FOOT FAULTS 305 

probably always remain so. A man can walk all day 
upon two legs without injuring them, but he cannot 
stand perfectly still on two feet for a single quarter of 
an hour without a crippling degree of fatigue and 
serious injury to his feet. To sufferers from flat feet 
the most important piece of advice would be, "never 
stand." If you can't walk, sit. 

Indeed, even when walking, a "third leg" in the 
shape of a stick or staff is most helpful and highly 
advisable. And one of the most striking and instinct- 
ively sensible traits of the outdoor worker, particu- 
larly the countryman, is the promptness and certainty 
with which the moment he ceases working or walking 
he either sits down upon some convenient stump or 
rail-fence or log, or proceeds to prop himself by leaning 
upon his fork or hoe. We have heard the story of the 
farmer who had a hired man so intolerably lazy that he 
was obliged to sharpen up all the stumps on his farm to 
a point to keep him from sitting down two thirds of the 
time. That hired man was not such a fool as he looked; 
he certainly knew what was good for his poor feet. 

For the prevention of flat foot, employers of laborers 
ought to be compelled, either by the pressure of indig- 
nant public opinion or by law, to provide plenty of 
chairs and stools for their employees to sit down upon 
at frequent intervals, and also to arrange to allow them 
to do as much of the work as possible sitting. In do- 
mestic service and in housework also, every room, and 
particularly the kitchens and washrooms, ought to be 
provided with plenty of chairs, and especially with 
one or more light high stools which can be easily 



306 COMMON DISEASES 

moved with one hand, and by the use of which a 
great deal of work, such as dish-washing, pie- and 
bread- making, cleaning vegetables, and preparing 
food, which is often done standing, could be done 
sitting. 

Nowhere else in the world could the doctrine of the 
cutting out of waste motion be more profitably applied 
than in the kitchen. Work should be carefully planned 
in advance so that everything required for the job 
should be got together at one place before the work is 
begun, and combination cupboards or kitchen cabinets 
arranged, which would contain all the accessories 
required for cooking operations within easy reach from 
the chair or stool placed at the table in front of it. The 
housewife ought to chase her brains about more and 
her feet less. 

Explorers report that there are certain tribes of 
Central African savages who march about through 
the forest carrying light one-legged stools permanently 
strapped to their persons. Grotesque as it may sound, 
some such habit as this would save an enormous 
amount of flat foot and tired backs. 

There should also be a much more abundant provi- 
sion in the way of seats alongmir parks and boulevards, 
and at every convenient angle, corner, and open space 
of all of our busiest streets. The famous Parisian 
boulevard habit of making streets and sidewalks wide 
enough so that rows of chairs, with or without tables, 
and seductive glasses of red and green liquids, can be 
arranged along them, is a most admirable one from a 
sanitary point of view and would greatly promote the 



FOOT FAULTS 307 

outdoor life and the health and enjoyment of our 
people if it were extensively imported to this country. 

Next in importance and helpfulness would come a 
law shortening and fixing the hours of labor for both 
housekeepers, domestic servants, salesgirls, and clerks, 
so that they should be able to get at least two hours a 
day exercise in the open air, and at the same time their 
wages should be raised, so that they could give them- 
selves an adequate amount of real food, well cooked 
and fit for human beings instead of for work cattle or, 
in case of too many domestic servants, more accurately, 
for pigs. Such a law would greatly diminish the amount 
of flat foot and all sorts of disabilities and diseases, and 
greatly increase the efficiency of those concerned; they 
would do more work in their shortened hours than they 
did in their day-long grind, and give better returns on 
their higher wages than on their old starvation ones. 
At least this has been the invariable result of the ex- 
periment wherever any one has had the intelligence, 
the nerve, and the humanity to try it. 

No matter what you may be discussing in the way 
of foot faults, you inevitably get back to tight shoes 
sooner or later. They are, as we have seen, a potent, 
predisposing cause of flat foot by making walking 
painful, while of all other common foot faults they 
are literally the first, last, all the time, and only im- 
portant cause. Corns, for instance, that commonest, 
most grotesque, and most disgraceful of foot faults, 
are due to just exactly one thing and one only, and 
that is pinching by a tight shoe. Really the poor 
corns themselves are not to blame in the least. In- 



308 COMMON DISEASES 

deed, they are trying to protect the softer tissues be- 
neath them from the jostling and poundings of that 
ruffian boor, the shoe. At bottom they are nothing 
more than small localized growths of thickened skin or 
callus, formed under pressure to protect the nerves 
and vessels, just as the soles of the feet and the palms 
of the hand thicken up and become horny under press- 
ure and friction. If the tool worker or farmer could n't 
grow healthy corns in the palms of his hands, and we 
all did not have flat natural corns upon our heels and 
the balls of our toes, we should find both walking and 
work so uncomfortable that they would be practically 
impossible. Corns are literally good men gone wrong, 
and where they make trouble for us is, after they have 
thickened up as much as they healthfully can, and the 
pressure instead of letting up still continues, they be- 
gin to overgrow in the form of a sort of wedge or blunt 
cone right down into the tender tissues which they 
originally set out to protect. 

There are lots of silly things that can be done to 
mitigate corns, such as scraping, paring, soaking in hot 
water, surrounding with ring plasters; but there is only 
one thing that can be done to cure them, and that is all 
that is necessary, — take off the pressure of the shoe 
at that point. No pinch, no corns. Of course, a corn 
which you have been nursing and developing at great 
pains and expense for ten or fifteen years, scraping it 
down carefully every night and chafing it up again 
in the daytime, is not going to wither and fall off in a 
single night like Jonah's gourd, the moment that you 
give your feet their freedom. 



FOOT FAULTS 309 

• Though after centuries of experiment, we are driven 
to the conclusion that " there 's nothing like leather " 
for all-round wear, it is well to utilize in their appro- 
priate place and season, especially for the upper parts 
of the shoe, softer, cooler, and more porous fabrics such 
as buckskin, linen, woolen cloth, or felt; also, wher- 
ever the nature of our occupation will admit, to plan 
to take off our shoes in the house, shop, or office, and 
wear light, comfortable, thick-soled, and broad-heeled 
slippers. The slipper habit ought to be much broad- 
ened and extended, and our silly conventions as to 
the impropriety or even indecency of wearing slippers 
ought to be abolished upon every and any sort of oc- 
casion indoors, and on fine weather even in the street. 
Broadly speaking, wherever and whenever slippers 
can be worn without undue risk of getting the feet 
chilled or wet and without danger of getting dust, dirt, 
gravel, or thorns into your feet, they should be worn. 
Most women, for instance, should wear slippers at 
least two thirds of the time, whenever they are in- 
doors or in their own homes or in their shops, facto- 
ries, or other places of work. And if most men in 
in-door or sedentary occupations would have the cour- 
age to do the same thing, it would greatly improve 
both the comfort of their feet and their own efficiency. 
It is a difficult matter always to get in a shoe for out- 
door wear a reasonable degree of water-proofness and 
protective toughness, combined with proper elasticity 
and sufficient porousness to allow the feet to breathe 
freely. Especially, when there is added the require- 
ment that the shoe shall have a sufficiently close sur- 



310 COMMON DISEASES 

face to be capable of taking a polish, which means 
that almost every natural pore in it is blocked up 
and then varnished over. Shoes for country or working 
wear, or for tramping, hunting, and outdoor sports, 
where the neat, trim appearance and polished surface 
are not essential, can be made self- ventilating and 
comfortable. But for city wear, probably the best com- 
promise, with the sinful conditions in which we find 
ourselves, that can be made, is to wear a sensibly 
shaped and well-fitting shoe of polished leather down 
to our place of business and there to exchange it for a 
comfortable well-fitting thick-soled slipper. The ideal 
arrangement, of course, is to wear shoes of such size, 
shape, and porousness that you are ready just as you 
stand to start off to do eight miles heel and toe at 
any time without a moment's preparation and come in 
without either sore toes or blistered heels. But this 
in the present state of human nature is a counsel of 
protection and few men have the courage of their con- 
victions, to a sufficiently high degree, to wear shoes 
that are really big enough for them and that actually 
and faithfully represent the shape of their feet. 

The problem of socks and stockings is really too 
deadly and puzzling for a mere man to tackle; only one 
or two broad and vague general principles can be laid 
down. First of all, darning is n't worth a darn. The only 
time in which it could be done to advantage was when 
socks were woolly, fuzzy things from a quarter to a 
half an inch thick. Second, don't wear coarse, hard 
fabrics, whether of cotton, linen, or wool, next to the 
feet; above all a sock should be soft and smooth. Third, 



FOOT FAULTS 311 

the best way to thicken up socks for winter wear is to 
put on one or even two extra pairs. There is no more 
merit in wool here than anywhere else on the surface 
of the body, for it is hot, scratchy, and sweaty. 
Fourth, holes in socks, — too big ones, that is, — 
when the edges begin to roll over and lump up, pro- 
bably cause almost as many blisters and chafes as do 
tight shoes. Buy inexpensive socks of any kind of ma- 
terial that is soft and looks pretty and throw them 
away as soon as they begin to wear out. You can't 
get anybody to darn them for you, anyway, whether 
married or single, in this twentieth century, and if you 
could, the darns would do your feet almost as much 
harm as the holes. Darn socks anyhow, they are a 
perpetual nuisance and you never know when you 
have got them right! This phase of the shoe problem I 
give up. 






CHAPTER XV 

OUR foot electrodes: thunderbolts that strike 

US THROUGH OUR FEET 

WE usually think of our heads as especially ex- 
posed to the thunderbolts of Jove, but as a mat- 
ter of fact, they strike us more frequently through our 
feet. Not only in the sense that a stroke of lightning 
is quite frequently upward, from the earth to the 
clouds, instead of downward, but also that of all the 
disasters and malicious animal magnetisms, embodied 
or disembodied, actual or astral, which strike our mor- 
tal frame, more gain access to our systems through 
our foot electrodes as they come in contact with the 
earth than by any other path except our noses and 
mouths. 

All the dangers that menace us from above, put 
together, — thunderbolts, meteors, cloudbursts, fall- 
ing trees, toppling chimneys, and collapsing roofs, — 
though vastly more dramatic and vividly dreaded, do 
not inflict one tenth, nay one one hundredth, of the 
actual damages upon humanity that spring from two 
such trivial and even ludicrous mishaps as stubbed toes 
and galled heels. In the picturesque metaphor of the 
Garden of Eden, one of the most effective methods of 
attack of the Serpent of disease upon the Seed of the 
Woman has been through all the centuries by bruis- 
ing his heel; and it was a curiously graphic and unin- 



OUR FOOT ELECTRODES 313 

tentionally accurate folk legend which made the heel 
of Achilles his vulnerable point. 

Possibly also the glass slippers of Cinderella were 
intended by the far-seeing wisdom of the Fairy God- 
mother as insulators against the danger of upward 
lightning stroke, though they do not seem to have pro- 
tected her for a moment from an acute attack of King's 
Sonstroke. 

One of the most interesting features of the advance 
of science is the unexpected way in which it often 
justifies and explains our instinctive wisdom. Ever 
since we began to plume ourselves on our first preten- 
sions toward civilization, we have obstinately insisted 
not only upon wearing shoes in spite of the way in 
which they punished us, but also in looking down 
upon and despising all those classes or races who did 
not. "Barefoot" is a term of reproach and contempt 
in almost every language and every age, and to appear 
in public with naked feet is looked upon as the last 
humiliation and gravest offense against that code of 
minor morals which we call etiquette or convention. 
Yet there are few prettier things on earth than a beau- 
tiful foot, and artists, reformers, and health preachers 
have lifted up their voices in unison to declare that 
the only natural and really healthy foot is the bare 
foot. For once, in the whole history of the universe, 
Mrs. Grundy was partially right, though of course it 
was quite unintentional on her part, and she had n't 
the least idea of the reason why. Her decision was 
based upon pure instinct as defined in that cynical dia- 
logue between a French father and his son: "What is 



314 COMMON DISEASES 

reason, father?" "Reason, my son, is that faculty 
which tells a man whether he is right or not." "And 
what is instinct?" "Instinct, my boy, is that faculty 
which tells a woman that she is right, whether she is 
or not." 

The taboo upon shoelessness appears to have been 
based upon the crude and highly illogical syllogism, 
successful people wear shoes, therefore it is a crime 
to go barefoot. The birth of the shoe for special occa- 
sions and occasional wear must have occurred very 
early indeed in human history, for although we use 
the term barefoot as one of the almost instinctive ac- 
companiments of the word savage, as a matter of fact 
there are comparatively few tribes, save in the very 
lowest levels of savagery, which do not possess some 
form of sandal, shoe, patten, sock, or moccasin of 
buckskin which they tie on and wear upon certain oc- 
casions or for special purposes, even though they go 
barefoot most of the time. 

The beginnings of the shoe habit are easily explain- 
able on grounds of comfort and increased efficiency. 
However passable a protection to our feet might have 
been afforded by the native leather of our thickened 
and calloused soles when engaged in such desultory 
pursuits as hunting and foraging for fruits, shrubs, and 
roots, there are two things you cannot carry on to 
any satisfaction and success without shoes , — war and 
work. The soldier cannot waste time or take his eye 
off the enemy long enough to pick his footing, so that 
the boots and spurs of the knight and the sabots of 
the villein alike became the symbols of their trade, 






OUR FOOT ELECTRODES 315 

and the badges of the rank of one, and the degra- 
dation of the other. 

The shoe is a work tool not merely in man but also 
in such animals as have risen (?) to the dignity of labor. 
Horses and oxen are, of course, habitually shod, and 
the romantically famous sledge dogs of the Arctic, 
Malamoot or Husky, travel much farther and safer 
if shod with carefully fitted skin boots, especially 
when there is a crust. In the case of all these beasts 
of burden from human to canine, the shoeing has 
often been so badly done as to bring severe penalties 
with it; but after all, the balance of the problem, to shoe 
or not to shoe, hangs pretty much as did the woman 
question in patrician Rome. Family life had come to 
such a pass on account of the encroachment of wives 
upon masculine prerogatives and their perpetual and 
increasing demands for greater liberties and wider 
privileges, that a meeting of alarmed husbands was 
called to discuss the situation. After several hotheads 
had spoken on the subject of immediate divorce and 
the boycott of marriage in the future, one, Caius Me- 
tellus, arose and bluntly reminded them that, although 
this fiery talk about freedom and separation sounded 
very well, the actual crux and impasse of the situation 
was, "That we cannot live comfortably with our wives, 
nor at all without them." 

Shoes are like matrimony, they require a good deal 
of intelligence and forbearance on both sides to keep 
life tolerable. 

But the utility of shoes, and such comfort as they 
may give, even together with their ornamental and 



316 COMMON DISEASES 

ceremonial aspects, are quite inadequate to account for 
the extraordinary universality and constancy of their 
wear, in season and out of season, indoors or outdoors, 
rain or shine, and the iron-handed tyranny with which 
such wearing is enforced under direst penalties of lack 
of social standing and respect of one's fellows if the 
custom be defied. 

It is just of recent years that we have discovered a 
factor which throws a flood of light upon the rigorous- 
ness of this taboo of unshodness, and which, though 
entirely unconscious, must have exercised a profound 
influence in placing the stamp of disgrace and dis- 
credit upon bare feet, entirely apart from the indica- 
tion of poverty involved. This is the surprising de- 
gree and frequency with which the germs of infectious 
disease and dangerous parasitic worms and insects of 
various sorts enter the body through the skin of the 
feet. 

We are very far from realizing to what an extraor- 
dinary degree our safety and our health depend upon 
literally "keeping a whole skin." Nearly one fpurth 
of our deadliest diseases are now known to enter the 
body through punctures and scratches in the skin, es- 
pecially those made by the bites of insects. And we 
are gradually being driven to the most unexpected con- 
clusion that the one single area through which the 
largest number and greatest variety of these infec- 
tions enter, is the skin of our feet. If we wanted to 
make a pathological paraphrase of the famous line, 
"My mind to me a kingdom is," it would run, "My 
skin to me a rampart is." One of our pathologists has 



OUR FOOT ELECTRODES 317 

actually laid down the dictum that there are two great 
classes of infectious diseases, those transmitted di- 
rectly by man, and those transmitted by insects. 

The reason why our feet are so frequently the port 
of entry of disease is twofold: first, that they are so 
readily scratched or bruised or punctured by flints and 
thorns and splinters; second, that those punctures and 
scratches are perpetually in contact with the ground 
where all our bacteria, disease germs, and parasites live. 
Whatever animals, birds, or human beings our disease 
germs now inhabit, they originally sprang from the 
soil and ultimately return thereunto, and most of them 
are capable of living for considerable periods, if not 
indefinitely, in the earth, especially if this be moist 
and warm. "Dust thou art, to dust returnest" applies 
not only to man, but also to most of the bugs that 
inhabit him. Here are a few of them which literally 
swarm in the soil of the cities and densely populated 
regions : the tetanus or lock-jaw bacillus, the bacilli of 
typhoid, of tuberculosis, of surgical fever, or blood- 
poisoning; in warm temperate climates the bacillus of 
the plague or Black Death, of cholera, and the now 
famous Necator Americana, which, being translated, 
means, The American Murderer, or the Hookworm. 
We think little or nothing of getting mud or dirt into 
a scratch on the foot, and indeed in northern and north 
temperate zones no injurious results may follow eight 
times out of ten, but on the other hand it is not too 
much to say were it not for this trivial accident there 
would be no hookworm, less than a fourth as much 
tetanus, one third less Black Death, and at least a 



318 COMMON DISEASES 

tenth less of crippling rheumatism of the feet and legs. 
Leather is one of the greatest antiseptics ever invented, 
and the shoe one of the most effective preventers of 
disease of any art, tool, or garment invented by man, 
save the use of fire upon his food. 

Take the case of the hookworm for instance. One 
would naturally and instinctively expect that a parasite 
which earns its living and bleeds its unsuspecting host 
at one and the same time, hooking itself on to the 
lining of his intestine just below the stomach by a ring 
of grappling hooks around its mouth which gives it its 
significant name, would certainly be carried into the 
body through the mouth upon infected food, drink, or 
fingers. Indeed, this method of infection was taken for 
granted at first, and the food of hookworm subjects 
rigorously examined for traces of eggs or larva? of the 
worm until it was shown that not only no contamina- 
tion of food could be proved but also, incredible as it may 
sound, eggs could be and were swallowed by volunteer 
physicians and medical students without the slightest 
infection by hookworm occurring. The eggs, in fact, 
were either digested in the stomach, or passed through 
the body unchanged, without developing either into 
larva? or mature worms. 

It was quickly found that the only place where the 
eggs of the worm, which pass in thousands from the 
body of a victim, would develop into the next, or larval 
stage, was in moist warm soil, particularly if this latter 
contained a good supply of fertilizer. Then it was found 
that if a little mud containing these larvae was smeared 
upon the skin of the hand, for instance, the infant 



OUR FOOT ELECTRODES 319 

worailets would instantly proceed to burrow into the 
skin, producing an intolerable itching in the process^ 
Thereafter the progress of the parasite was traced 
through series of animals and put together link by link, 
until the entire astounding March of the Hookworm was 
laid bare. He bores his way through the skin and keeps 
on boring until he breaks into a capillary or small vein. 
Along this he is swept by the blood current to the heart, 
and from there pumped through the circulation to the 
lungs. In the spongy swamp of tiny blood-vessels in 
the lung he wakes up from his trance and proceeds to 
bore his way out of the blood-vessels again through the 
wall, just as he entered them, until he strikes air this 
time instead of water, and emerges into one of the small 
bronchial tubes. Up this he slowly crawls, relentless 
as fate, having now attained his full growth, and being 
about three quarters of an inch long, until he reaches 
first the windpipe, then the top of the larynx in the 
throat, from which he tumbles triumphantly into the 
gullet, is swallowed into the stomach, passed on into 
the intestine, and there anchors himself for life to 
suck blood through one end of him and pour eggs into 
the intestine from the other until death doth him part. 
But where does he get the chance to penetrate the 
skin of the body under the sheltering cover of a coat of 
mud? Naturally most promptly and readily on the 
feet; and here the last link in the chain was forged and 
a puzzling question solved at the same time, namely, 
What was the origin and causation of an exceedingly 
common and troublesome itchy inflammation of the 
skin of the feet and ankles, well known all over the 



320 COMMON DISEASES 

Southern States and wherever hookworm is found, 
under the names of Ground Itch, Toe Itch, Dew Itch, 
or simply Ivy Poisoning of the foot? Every one of 
these torturing rashes which kept the luckless small 
boy awake and scratching half the night long, indeed 
howling with the intensity of his discomfort, was found 
to be nothing more than the bonfire and display of 
fireworks lit up by the hookworm to celebrate his 
triumphant entrance into the body of another victim. 
The whole vicious circle and round dance of death from 
stomach to soil, from soil through the webs of the toes, 
from toes to heart, from heart to lungs, from lungs up 
the windpipe into the gullet, and from gullet to in- 
testines, sounds as grotesque and incredible as a tale 
from the Arabian Nights. But it is a most painfully 
sober and scientific fact, and a sixteenth of an inch 
of shoe leather breaks the circle and stops the Dance 
of Death at once and forever. 

This risk from going barefoot extends over nearly 
half the geographical area of these United States, not 
to mention our tropical possessions, and how far it is 
from being an imaginary danger or theoretical risk, 
may be gathered from the appalling pyramid of re- 
sults of examinations of successive groups of the pop- 
ulation which has steadily been piling up for some four 
years past; beginning with classes of medical students, 
who offered themselves for examination, then extend- 
ing to large groups of college and high-school students 
all over the infected area, then to militia in camp in the 
various state musters, then to children in small town 
and country schools, with the staggering result that 



OUR FOOT ELECTRODES 321 

never were less than fifteen per cent of the young people 
examined found to be harboring hookworms as non- 
paying guests in their alimentary canals, while from 
that the percentage steadily mounted, ranging from 
fifteen to forty in college students, from twenty-five to 
sixty in militiamen, and from twenty to eighty in school 
children. The proof, of course, was simplicity and in- 
escapableness in itself, namely, the discovery with the 
microscope of hookworm eggs in the discharges from 
the bowels. 

It should be made a misdemeanor by law for a 
parent or guardian to allow any child living south of 
a line drawn about the level of Baltimore clear across 
the United States, to go barefoot in the open country 
in summertime. 

And indeed, while I am most reluctant to lay profane 
and destroying hands upon such beautiful idyls and 
charming memories of the past as centre around " the 
barefoot boy with coat of tan, " or to rob the rising gen- 
eration of such keenly remembered delights as the cool, 
soft feel of the dewy grass under your emancipated 
feet, and the delicious quiver with which the soft mud 
would squiggle up between your toes after a rain, yet a 
sense of duty and truthfulness compels me to the bleak 
and joy-destroying statement that the advantages and 
joys of going barefoot in summertime, even in northern 
climates, are at least two fold overbalanced by the risks 
and discomforts involved. Why even when we were 
boys we expected to have either a " stun-bruise " or a 
sore heel or a barked toe or a festering stab or scratch 
from a thorn or splinter, to say nothing of buried briar 



322 COMMON DISEASES 

thorns and thistle stickers and bee stings on one or 
other foot all the time. And since I have had the oppor- 
tunity to observe this darling practice from the cold 
and unsympathetic point of view of the "beastly 
grown-up," both as family physician and paterfamilias, 
it has been borne in upon me very strongly and pain- 
fully that scarcely a summer passes over the head, or 
more accurately, under the feet, of the barefoot boy, 
without the development of half a dozen nasty local 
sores, and usually of one or more general, and some- 
times dangerous, blood poisonings. 

Unfortunately the places where they could run bare- 
foot with least risk, the city pavements and streets, 
which, with their waterproof surfaces and frequent 
cleanings are now among the cleanest patches of 
"ground" upon earth, do not invite in the least bare 
soles and tender toes by their hard and stony surfaces, 
and equally unfortunately the regions which most 
invite the toes of youth out of their leather chrysalis 
cases, — gardens and barnyards and cultivated fields, — 
are precisely the places where the deadliest of ail the 
earth germs, the tetanus bacillus, is most likely to lurk. 
It is true that he causes only a few thousand deaths 
each year, but it is hardly worth while letting your 
child run the risk of being one of those few thousands, ' 
for of all the painful and distressing methods of shuf- 
fling off this mortal coil, death in lockjaw convulsions 
is one of the worst. 

These tetanus bacilli get into the earth, of course, 
from the intestines of their ordinary host, the horse, 
through the standard use of horse manure as a fertil- 



OUR FOOT ELECTRODES 323 

izer, and even if these should be absent there are a 
score of other species of bacteria from the intestines of 
the cow, the pig, the dog, and the chicken which swarm 
in well-manured soil, and of course the richer and more 
highly fertilized the soil the more abundant will be its 
crop of germs. If your child is well shod and its hands 
kept fairly free from cuts and scratches, it can play in 
even the most lockjaw and colon-bacillus infested soils 
with "perfect impurity " as Mrs. Partington used to 
say. 

But what advantage does it gain from going bare- 
foot which in any way offsets or counterbalances even 
this remote possibility of lockjaw or other serious infec- 
tion, the strong probability of some form of blood poi- 
soning, and the absolute certainty of ulcers and sores 
from festering cuts in which the living filths of the soil 
grow and flourish ? Frankly, I know of none except the 
pleasure of feeling the soft earth and the cool grass 
under foot, and a sense of freedom in your liberated 
toes. But does n't it help your feet to gain their natural 
shape and vigor and escape from the crippling and de- 
forming effects of shoes? For every relief which it offers 
in this respect it exposes the feet to at least ten new 
dangers. I am as keenly aware as most men of the 
absurdities and evils of shoe wearing, particularly of 
certain fashionable shapes, but as Sainte-Beuve re- 
marked, "II ne faut pas calomnier raeme Plnquisition" 
("It is not necessary to slander even the Inquisition"), 
and there is no doubt that a great deal of unmerited 
abuse has been heaped upon our valuable servant, but 
dangerous master, the shoe. 



324 COMMON DISEASES 

For instance, it is customary to declare that the 
shortened and often distorted form of the little and 
next to the little, or fourth and fifth toes, is entirely 
due to crowding the foot into a narrow and pointed- 
toed shoe, in the hope of endowing a shapeless pedal 
extremity with artistic merit. Also that the huge and 
buniony bump at the base of the great toe is due to 
a similar distorting pressure by pointed-toed shoes 
crowding the great toe outward and toward the other 
toes in the attempt to narrow the paddle-shaped front 
of our hind paw. These accusations sounded perfectly 
plausible and convincing so long as we confined our- 
selves to a study of civilized feet, which had always 
worn shoe leather. But the moment we went further 
afield it did n't take us long to discover that while 
tight shoes have undoubtedly aggravated both of 
these deformities, they most certainly did not cause 
them, because both are to be found blossoming in full 
perfection in savages who have never worn shoes, or in 
civilized races who habitually go barefoot. Some of 
the worst and most disfiguring cases that I have ever 
seen, both of "bumpy" and bent-out great toes, and 
short and crooked little toes, have been in savages who 
never wore a shoe in their lives, save an occasional 
moccasin or sandal, or in European peasants who 
never wore theirs save on market day or Sunday. 

In fact, the dwindling of the toes on the outer side of 
the foot and the overgrowth of the toe on the inner side, 
are simply part of the great general tendency all 
through the animal kingdom to get rid of one or more 
of their original group of five toes and to concentrate 



OUR FOOT ELECTRODES 325 

and enlarge the remaining one or two, whenever these 
are used solely for purposes of support and locomotion, 
and not for digging, climbing, or scratching. The dog, 
for instance, has only four in front and three behind, 
the tapir, three, the cow and the sheep, two, and the 
horse, finally, one. The process, in fact, of shrinking 
of the small toes and the enlargement and turning out 
of the large toe, must have begun at least two hundred 
thousand years ago, and as we have abundant evi- 
dence, was in full swing in the Cave Men on the edge 
of the receding glacial ice sheet. 

If any one has any doubt in his mind as to how 
modern a disease shortened and crooked little toes are, 
he can resolve it very quickly by paying a visit to any 
art museum or gallery, where there is a good collection 
of copies of those wonders of the world, the classic 
marbles and sculptures of Greece. There he will quickly 
discover on even those ideals of physical perfection, 
such as have never been excelled or indeed equaled, 
little toes so short as to look like hazelnuts stuck 
on the side of the foot, second toes crooked and kinked 
upon themselves in the deformity known as " hammer 
toes," and great toes swollen at the base and twisted 
so far outward that a line drawn through their centre, 
instead of running back to the centre of the heel, runs 
two inches clear of the heel altogether and strikes some- 
where near the centre of gravity of the other foot. Yet 
these superb creatures had never worn anything but 
sandals, consisting of merely a sole held on by thongs 
and straps. The outer toes of the foot have shortened 
and atrophied, and the inner, or greater, turned out- 



326 COMMON DISEASES 

ward, both for the same purpose, namely, simply to 
allow the foot to roll over easily in walking or running 
so that we may push off from the outer or inner 
border of it according as we toe in or toe out. Ever 
since we began to dissect the human body we have 
known that the fifth or little toe has shrunk so much 
that it consists frequently, indeed usually, of only two 
bones or joints, instead of three as do its neighbors. 

Indeed, much and justly as we may blame and 
denounce certain absurdities in our civilized shoes, we 
have only to glance at the feet of a group of savages 
or European peasants to see at once that they have 
saved us at least from twice as many deformities as 
they have inflicted upon us. A more distressing collec- 
tion of bumps, swellings, deformities, and distortions, 
splay feet, scars and blemishes, deformed nails, and feet 
like the flippers of the seal, could hardly be made any- 
where in civilization among the highest-heeled and 
narrowest- toed shoe wearers, than can be rounded up 
in a couple of hours in any Indian camp or peasant 
gathering that does not demand the donning of shoes 
as a matter of etiquette. 

When it comes to protection from the diseases and 
infections that may enter through cuts and scratches 
on the feet, we are instantly confronted with the fact 
that the shoeless savage or barbarian of the tropics or 
sub-tropics, the world over, has anywhere from a dozen 
to a score of diseases, some of them exceedingly serious, 
which the nations that habitually and constantly 
wear shoes, know nothing of. Hookworm, for instance, 
instead of being in any way peculiar to the southern 



OUR FOOT ELECTRODES 327 

half of North America where we have been unfortunate 
enough to bump into it personally, is one of the great 
world infections and extends in an almost unbroken 
belt completely round the circumference of the globe at 
its broadest and most densely populated part, namely 
from about thirty-five degrees above the equator to 
about thirty-five degrees below. It rages all through 
Central Africa; indeed our American form was un- 
questionably imported into this country in the bodies 
of African slaves, thus wreaking a most disastrous and 
poetic vengeance upon their oppressors, for our Ameri- 
can worm has now been shown to be identical with 
the African species. Another closely related species 
scourges the Mediterranean basin, southern Europe as 
well as northern Africa, and still another devastates 
India, southern China, the Malay Peninsula, and the 
East Indies. Altogether this amazingly insignificant 
little pest, for all the world like half an inch of wet 
cotton thread, causes tens of thousands of deaths, and 
lowers the working efficiency of the survivors from 
fifteen to fifty per cent. Just to wipe him out alone 
would increase the productive efficiency, the potential 
H. P. of mankind, at least twenty-five per cent. And 
he can be "shooed" out of existence, even though his 
twin pest, the domestic fly, cannot. 

The next great infection the shoeless races are unpro- 
tected against is that fearful plague, the Black Death, 
or Bubonic Plague. It is too long a story to go into 
detail; suffice it to say in brief that when the bacillus 
pestis has killed its human victim, as it does about nine 
times out of ten that it attacks him, it must undergo a 



328 COMMON DISEASES 

sort of transmigration through first the body of the 
human flea, then the rat, then the rat flea, and by the 
bite of the last insect the human victim again. In all 
these stages it swarms in and infests the soil, and 
whether it be that the flea, living like all other fleas 
chiefly in the dust and in the dirt, bites the naked foot 
or ankle more readily than any other part of the body, 
or whether it be that the bacilli can find their way di- 
rectly from the soil into the body of a new victim with 
wounds or scratches on his feet, certain it is that a very 
large share of the victims of plague are infected through 
their feet and legs. Indeed, it is this port of entry that 
has given the disease its name, bubonic, from the fact 
that the germs entering the body through the skin of 
the feet and legs are carried through the lymphatics 
into the great chain of glands in the groin, where they 
are arrested and give rise to the hot, purple, angry 
swelling known as bubo, and which is the first recog- 
nized and characteristic sign of infection. A similar 
bubo forming in the armpit comes from the penetra- 
tion of the poison through bites or scratches on the 
hands and arms. 

Whatever may be the exact method of penetration 
into the system, it is absolutely certain that the disease 
seldom, or never, attacks the shoe wearer, — those who 
constantly wear shoes. Time and again native regi- 
ments employed in the fearful outbreaks in India (the 
last of which, closing less than five years ago, struck 
out of existence nearly thirty millions of people inside 
of ten years, without so much as causing a ripple on this 
side of the Atlantic), in cleaning up the plague-infected 



OUR FOOT ELECTRODES 329 

quarters, were literally up to their ankles in infected 
filth, but never developed the disease as long as they 
continued to wear their shoes. If, with Oriental econ- 
omy, they stripped off their beautiful and expensive 
shoes, and went at the job barefoot, there was certain 
to be a considerable sprinkling of plague cases among 
them. So that the shoe, bad as it often is, is far the 
less of two evils. 



CHAPTER XVI 

THE LESSER PERILS OF COUNTRY LIFE: SNAKES IN THE 
VACATION EDEN 

IT is trifles that wreck philosophies, and pin-pricks 
that murder happiness. Ever since literature be- 
gan, poets have sung of the joys and beauties of coun- 
try life, and philosophers have expatiated upon its dig- 
nity and peaceful calm. But these, for the average, 
matter-of-fact man, are almost overbalanced by such 
trifles as cold in winter, mud in spring, dust, heat, and 
flies in summer. 

Man was born in a garden, it is true, but he has been 
doing his best to get away from it ever since; and 
among the "angels with the flaming sword" that have 
driven him out of the rural Eden, not the least potent 
have been those tiny hosts that bite and buzz and sting. 
The Bard of Avon, in his matchless carol, "Under the 
Greenwood Tree," rashly declares: 

"Here shall we see 
No enemy 
But winter and rough weather"; 

but he totally forgets to mention the most prominent 
inhabitants of the mossy shades during any season of 
the year when it is possible to 

" Tune one's merry note 
Unto the sweet bird's throat." 



SNAKES IN THE VACATION EDEN 331 

I mean mosquitoes, horse-flies, midgets, ants, and hairy 
caterpillars. But then, poets are always so absent- 
minded — or perhaps even Shakespeare did n't know 
any good rhyme for "caterpillar." 

In like high rhapsody, Andrew Marvell, in the deli- 
cious solitude of his orchard, can sing — 

" My mind from pleasures less, 
Withdraws into its happiness, 
Annihilating all that 's made 
To a green thought in a green shade." 

Evidently there were no gnats or gad-flies in that or- 
chard, or even quaint old Andrew would have found one 
part of "all that's made" which declined to be "anni- 
hilated to a green thought" by any such poetic pro- 
cesses. 

I have always felt profoundly skeptical, too, about 
the truth of the story that Sir Isaac Newton thought 
out the whole theory of gravitation under an apple-tree, 
after an apple had fallen on his head. If he had sat still 
for any length of time under an apple-tree, a thought- 
dome as large as his must have collected at least four 
caterpillars, three spiders, a beetle, and a couple of 
dozen flies, any one of which would have thrown the 
most powerful train of thought off its track. 

Some cynic has declared that one reason why 
people are crowding into the city is that it is the only 
place where one can live the outdoor life with any com- 
fort — in the roof-gardens, on the pavements, and on 
the bleachers. Certain it is that nine times out of ten, 
when dwellers in the country want to enjoy themselves, 
they go indoors. In most parts of the United States, 



332 COMMON DISEASES 

during the season in which the weather permits one to 
sit out of doors with any comfort, life is rendered a 
burden by flies, gnats, and mosquitoes, unless behind 
the protection of screens. For both town and city 
dwellers, these winged pests are the most serious ob- 
stacle to living the outdoor life, and particularly to 
sleeping in the open air, or with windows wide open. 

"But why," inquires some superior person, "should 
we make these insect molehills into mountains, and 
dignify such trifles by dwelling upon them? Still more, 
why let them interfere with our happiness or our peace 
of mind?" 

Until a decade or so ago, the superior person had the 
advantage of us. We had no answer ready for his lofty 
question. There appeared to be no adequate reason 
why we should not wrap ourselves in the mantle of 
a stoic philosophy, and decline to be irritated by pin- 
pricks. We knew perfectly well that by sitting placid 
and unresisting, and possessing our souls in peace, the 
sum total of injury that we should suffer in an entire 
summer evening would be a few trifling punctures, and 
thirty minutes or so of itching. 

Yet the individual was never yet born who would 
accept the situation in that sweetly reasonable light. 
One single sting is enough to set a man slapping and 
slamming wildly at his luckless face, to raise every 
ounce of him to fever pitch, to make him renounce his 
religion and turn from a cultured and civilized being 
into a bloodthirsty Comanche. Even where no bite is 
felt or feared, the mere tickling, clinging, crawling of 
a fly across the skin annoys us, as the late Bill Nye 



SNAKES IN THE VACATION EDEN 333 

expressed it, "as much as if he were a mule with red- 
hot shoes on." 

To-day we can look the superior person fearlessly in 
the eye. Even our bad temper has been triumphantly 
vindicated. Nature knew what she was about when 
she made us loathe a fly, hate a gnat, and execrate a 
mosquito. They and their like are the deadliest ene- 
mies of mankind. The real battle of the human species 
for the possession of the earth — nay, even for the 
right to continue to exist upon its surface — must be 
fought, not with mammoths, but with mosquitoes; 
not with lions and tigers, but with flies and gnats; not 
with behemoths, but with bacilli. 

Our instinct to kill insects at sight is perfectly sound. 
Out of the quarter of a million species now known to 
science, a mere handful are even remotely helpful to 
man, and most of these only by their power of living 
upon other and more dangerous insects. On the other 
hand, thousands of species are actively hostile to man, 
to his food-plants, and to his domestic animals. Whole 
tribes have been swept out of existence by the attack 
of insects carrying bacilli — as within the last two 
decades, in Central Africa, by the dread "sleeping 
sickness " carried by the tsetse fly. Whole nations have 
been weakened and crippled, and whole civilizations 
retarded, by another insect-borne disease, malaria. 

Indeed, recent investigators have advanced the 
theory that the historic decline of both Greece and 
Rome was largely due to the ravages of this disease, 
brought into Europe by armies returning from wars in 
Asia and Africa. It may yet come, when we see things 



334 COMMON DISEASES 

in their true perspective, that the warriors of civilized 
nations will turn from slaughtering one another to 
battling against our insect enemies. 

There is a Thirty Years' War for every uniformed 
soldier 6n the face of the earth against the mosquito 
alone, which would be attended by all the adventure, 
excitement, and risk of life, of actual warfare, develop- 
ing to the full the military virtues of courage, ini- 
tiative, daring, and devotion ; and which, when it was 
ended, would have saved millions of lives, instead of 
destroying tens of thousands. It would have added 
nearly one fourth to the area of the inhabitable and 
productive regions of the globe. Turn every cannon 
and every battalion of artillery in the world against 
that Angel of the Pestilence, the house fly, and in ten 
years he would be exterminated, root and branch; and 
with him, half of our fifty thousand deaths in the 
United States every year from the summer diseases of 
children, one third of our dysenteries and summer 
sickness and cholera morbus, and one fourth of our 
typhoid, with not a little of our tuberculosis, our teta- 
nus, and our boils and blood poisonings. 

However, insects cannot be cast for the comfort- 
ing part in life's drama played by the Devil of the old 
theologies, as an universal scapegoat and excuse for 
all human frailties and misfortunes. Dangerous and 
deadly as they are, they are only "middle-men," dis- 
tributors, common carriers of evils which they have 
picked up from outside sources. For the most part, 
those outside sources are diseased or dirty human 
beings. So that we have really ourselves to thank for 



SNAKES IN THE VACATION EDEN 335 

most of the damage they do. The mosquito does not 
hatch, or create, in his own body, the germ of the dis- 
ease that he carries, but sucks the plasmodium of 
malaria, and the poison of yellow fever, out of the 
blood of some human victim suffering from those dis- 
eases. So that malarial and yellow-fever districts now 
carefully screen the sufferers to prevent them from 
infecting the poor mosquitoes, and we can attack 
the spread of insect-borne diseases from both ends, as 
it were. 

More important yet, closer study of their habits 
during the past five years has brought out the curious, 
and at first sight, incredible, fact that the majority of 
these insects which carry disease, such as the malarial 
mosquito, the yellow-fever mosquito, and the house fly, 
can live and multiply, apparently, only in the immedi- 
ate neighborhood of human habitations. In other 
words, they are literally domestic animals, and part of 
our farm stock. This is absolutely true of the house 
fly and the yellow-fever mosquito, neither of which is 
ever found more than a mile or two, and usually not 
more than a few hundred yards, away from human 
habitations. Numerous species of the Anopheles, the 
only mosquito that can carry malaria, are found in 
the uninhabitable swamps, but seldom in numbers to 
exceed more than about one to the thousand of mos- 
quitoes of other species. While in the houses and out- 
buildings of malarial districts, they will sometimes 
form one fourth, or even one half, of the mosquito 
population. Either they need a supply of human blood 
to enable them to thrive, or what is more probable, the 



336 COMMON DISEASES 

pools and ponds and water holes and shallow wells and 
reservoirs, formed either intentionally, or uninten- 
tionally, by man in his settlements, furnish them the 
special kind of breeding ground that they need. In 
every case, the consoling and most important fact re- 
mains, that we have the fate of all three of these insect 
pests in our own hands and can tolerate them, or wipe 
them out of existence, at will. 

However, mosquitoes, gnats, and midges, whether 
they carry disease or not, are insufferable nuisances, 
like Mr. A. Ward's "Injuns," "pizen wherever found "; 
of no earthly advantage to us physically, and fearfully 
detrimental morally and religiously, and should be 
wiped out of existence everywhere in the neighborhood 
of human habitations. This sounds like a large order, 
but it is n't half so difficult as it sounds, unless you 
happen to be unfortunate enough to live within half 
a mile or so of some large undrainable swamps, or 
within four or five miles of salt marshes and tidal pools. 
Here, as often elsewhere, our foes are literally "they 
of our own household"; and a strict draining and 
cleaning up of your own grounds, garden, stable, 
barnyard, and back pasture will be sufficient largely 
to rid you and your verandas of these insect pests. 

The method of operating against them is that of 
good King Herod — strangle them in their cradles. 
The one thing that all the tribes that buzz and sting 
require above everything else, is water to breed in. For 
some of the gnats and midges, merely damp, shaded, 
undrained ground is sufficient; and though much of 
this sort of surface can be got rid of by proper soil 



SNAKES IN THE VACATION EDEN 337 

drainage and by clearing up of thickets and under- 
brush so that the sun and air can reach the ground 
everywhere, they cannot always be entirely exter- 
minated. But as their activity is greatest in the early 
spring when few summer visitors are in the country, 
and they are not known to carry any disease, — 
although one gnat (Simulium) is suspected of carrying 
the dread sub-tropical disease pellagra, — this is a 
comparatively easy matter. 

No artificial thicket should be tolerated about a 
garden, or grounds, through which the sunlight and air 
do not penetrate freely; and where pine woods, or 
natural thickets, near a house cannot be cleared suffi- 
ciently for this purpose, the condition can be consider- 
ably improved both for gnats, midges, and the smaller 
varieties of mosquitoes, by sprinkling any damp places 
in the ground, or marshy, mossy spots, with kerosene, 
or any form of crude or refined petroleum, two or three 
times a month. 

All mosquitoes, however, and indeed most gnats and 
wood flies of any size, or viciousness, pass through an 
aquatic stage in the wriggler or larval stage of their 
development, which requires water in fair depths and 
amounts for them to swim in; their periods varying 
from two to six weeks. Indeed, in the case of the most 
dangerous of all, the malarial mosquito, three months. 
The keynote of our campaign is to deprive them of this 
water, lacking which, they are utterly unable to de- 
velop. Go over every square yard of the territory 
within two hundred yards of your house, and wherever 
you find a hollow in which water accumulates during 



338 • COMMON DISEASES 

rain, a pool or marshy spot, a tub, or ornamental pond, 
either fill it up, drain it, or coat it with coal oil, and you 
will find that you have, in nine cases out of ten, practi- 
cally rid yourself of mosquitoes and gnats. 

It is almost incredible what short-lived and appar- 
ently trivial accumulations of water will suffice for 
some of these pests to breed in. Anything that will hold 
water three fourths of an inch or more in depth for ten 
days, is sufficient; even such exceedingly insignificant- 
looking lake basins as a tomato can, or a sardine tin, 
or an old boot, or rubber, or the hollow of a broken 
piece of crockery, if they happen to be shaded so that 
the sun cannot evaporate within ten days the water 
which they may catch during a rain storm. 

Even the buildings themselves should be inspected 
for catch-basins of this description, as was illustrated 
in the most surprising manner, in the campaign of ex- 
termination waged with such success against the late 
epidemic of yellow fever in New Orleans. The prin- 
cipal breeding place of the yellow-fever mosquito 
(Stegomyia) was found to be the cisterns in which rain 
water was caught and stored for household water. 
But even after these had been thoroughly cleaned out 
and screened over with the finest of wire mesh, certain 
of the infected houses were found to be producing new 
broods of mosquitoes. They seemed to be coming out 
of the rooms themselves, and were not found in the 
yards or gardens surrounding. A little closer search 
revealed the astounding fact that they were actually 
breeding in the pitchers of water kept standing in the 
bedrooms, the careless negro servants being in the 



SNAKES IN THE VACATION EDEN 339 

habit of simply filling up the pitchers every day with 
fresh water, without taking the trouble of emptying 
out the old water, or cleaning the pitchers. 

If there be a water-butt or cistern anywhere about 
your premises, empty it and clean it out thoroughly 
to destroy any wriggling larvse, which may be already 
present in it; and then cover it over either with a solid 
cover, or with a fine mesh wire screen. Shallow wells 
should also be carefully boxed over and closed in 
tightly; thus preventing the entrance of mosquitoes, 
as well as of accidental fouling. Where there are any 
accumulations of water, such as lily ponds, fish ponds, 
duck ponds, or the like, that you cannot make up your 
mind to get rid of, they can be rendered comparatively 
safe by pouring kerosene upon their surface at the rate 
of a gallon for each thousand square feet, two or three 
times a month . This acts in two ways, both in being 
directly poisonous to the mother mosquito when she 
approaches the water to desposit her eggs, and by 
forming a film over the surface of the water which 
prevents the larvae from getting air when they come up 
to the surface to breathe, after their curious amphibi- 
ous fashion. One or two species, it is true, are able 
to break through this barrier by the curious device of 
an odd extensible air tube, which they can push up 
through the film; but they are neither numerous nor 
troublesome. 

Where large swamps or ponds, lakes or rivers ex- 
ist in the neighborhood, within half a mile or so, then 
joint action on the part of the community is needed. 
But even this is neither as expensive nor as difficult as 



340 COMMON DISEASES 

might, at first, be supposed. It has long been known 
that mosquitoes are not nearly so troublesome along 
the banks of deep, swift-flowing rivers, or around lakes 
with clean, sandy, or steep rocky shores, as they are 
in shallow pools and swamps. The reason for this is 
that the deadliest enemy of the mosquito larva are fish 
of all sorts, particularly minnows, perch, sun-fish, and 
the like. Wherever they can freely penetrate, not 
many mosquito babies have a chance to survive; so 
that even where a large-sized pond, lake, or river is to 
be attacked, the only part really requiring attention 
is its margin, where, as the water of the pond or river 
falls during summer, little pools or swampy places 
may be left behind, which are cut off from the main 
body of the pond, and which fish, however small, 
consequently cannot penetrate. These can usually be 
dealt with quite readily in various ways, according 
to their size: if they are very small, by filling up; if 
a little larger, by coating, or by a short ditch to drain 
them into the main body of water. If this be pre- 
vented by rocky ledges, or other obstacles, they can 
be coated with kerosene, or by ingeniously impress- 
ing Nature's check against the mosquito into our 
service, by stocking them with small fish. Four or 
five shiners, or small fish, dipped out with a fish net 
and dumped into one of these ponds, will live like 
lords on mosquito omelettes furnished them over night 
by the trustful mother birds. 

Even the apparently hopeless task of attacking the 
pools and inlets and salt marshes and salt meadows 
of the sea coast can be undertaken with fair prospects 



SNAKES IN THE VACATION EDEN 341 

of success. The same principles apply here. Pools or 
creeks which are filled at every tide need not be inter- 
fered with, the fish will take care of them; it is only 
these tidal pools high up on the beaches which are 
reached only at the highest tides every month, and 
then left completely isolated, that require attention. 
These can either be drained by cutting a ditch through 
the sand ridge which holds them there, by stocking 
with fish, or coating with oil. 

The beach, or salt, mosquito is peculiarly trouble- 
some because, contrary to the almost invariable rule of 
the fresh-water mosquitoes, who are " home bodies," 
and limit their activities, except when carried by 
winds, to an area of only a few hundred yards and 
often a few hundred feet from the place they are 
hatched, he rises high into the air and, launching his 
aeroplane upon the sea breezes, will be carried ten, 
twenty, and even thirty miles inland. Why they do 
it is a mystery, for these profanity -breeding swarms, 
which form the great masses of the world-famous Jer- 
sey mosquito, consist almost entirely of sterile females 
who never return to the place where they were born, 
nor reproduce their kind anywhere else. It really 
looks as if they enjoyed the exasperation they produce 
sufficiently to travel thirty miles to bite somebody; 
one of the few instances in nature of original sin or 
pure cussedness. 

Their fertile sisters, by the way, who are only about 
one one-hundredth as numerous, mate and settle down 
and go to light housekeeping at once, within a few 
hundred feet of the pool in which they were bred; and 



342 COMMON DISEASES 

make no trouble for anybody, except perhaps their 
husbands, and a few rash and red-nosed fishermen 
who deserve all they get. These were the bush- 
whackers who for several years thwarted the success, 
and brought ridicule upon the public campaigns of 
extermination against the mosquito along Staten Is- 
land and the Hackensack marshes. But their secret 
has now been learned, and prohibition is beginning to 
really prohibit. 

Of course these methods are inapplicable when 
camping out, or hunting, or fishing, partly on account 
of the large area which would have to be covered, and 
partly from the fact that either from the nature of the 
sport, or game, or for the sake of water supply, camps 
almost always have to be in some region where there 
are plenty of breeding places for mosquitoes. It is, 
however, well worth while when pitching your tent, or 
making camp, to go even fifty or a hundred yards from 
the water for the sake of getting up on some hill 
or ridge above the level of the surrounding country, 
and especially where there is an opportunity for a 
breeze to strike between you and the nearest water. 
On the prairies, or in thin woods, an elevation of even 
only ten or fifteen feet, which catches the breeze, will 
make all the difference in your comfort between 
heaven and the other place. 

The mosquito is a very weak flier, carries an enor- 
mous sail area in proportion to his beam and tonnage, 
and like most balloons, even dirigible ones, can fly- 
only with the wind, scarcely at all across it, and not 
an inch against it. If the camp is to last for more than 



SNAKES IN THE VACATION EDEN 343 

four or five days, it is well worth while to patrol the 
swampy places, the edges of lakes and pools within a 
hundred yards of it, with the kerosene can. This may 
do much to mitigate your tortures, if it does not en- 
tirely relieve them. 

The various methods and means of endeavoring to 
prevent mosquitoes from biting after they have actu- 
ally arrived upon the scene, are simply exasperating 
in their inefficiency. Most of them consist of volatile 
substances, usually aromatic oils, or essences, which 
are supposed to give off vapors irritating, or repulsive, 
to the mosquito. If they could be applied to the mos- 
quito directly, instead of to your unfortunate face and 
hands, they might do some real good. But most of 
them appear to have the unfortunate faculty of being 
more disagreeable to your skin, or your olfactory nerve, 
than they are to the mosquito. A few of them, such 
as the famous old oil of pennyroyal and that good old 
stand-by, beech tar, may possibly discourage six out 
of the dozen mosquitoes who would otherwise have at- 
tacked you. But you won't be able to distinguish much 
appreciable difference between the annoyance and ex- 
asperation caused by the half dozen bites and that of 
the whole dozen. Beech tar, if applied after the an- 
cient fashion of the woods, that is to say, a full coat on 
entering the woods, an additional one every morning 
and evening, and no washing until you return to civ- 
ilization may, with the assistance of wood smoke, dust, 
and fish slime, protect you by producing a coating 
which would turn the bill of even the most ferocious 
bloodsucker. 



344 COMMON DISEASES 

Much the same verdict must be passed upon the 
various methods of filling the air with irritating va- 
pors. If they are thin, they are a delusion and a snare; 
and if thick enough to be effective, torture their mak- 
ers more than they do the insects. The old familiar 
smudge will drive away a few of the lighter -minded 
and more trifling young females, or giddy old spin- 
sters, of the buzzing crowd; but a really determined, 
hungry old hen mosquito, loaded with eggs and deter- 
mined to have a meal of blood for her coming brood, 
will plunge through the thickest smoke and get it with 
the courage and determination of the Light Brigade at 
Balaclava. 

Measures for the relief of discomfort after the bite 
has been inflicted are numerous, but as everywhere 
else in medicine, their unsatisfactoriness is in direct 
proportion to their number. Almost everybody knows 
a "sure cure" for the itching of mosquito bites. But 
it is either never available, or refuses to work on any- 
body but the one who recommends it. There is a valid 
reason for this ineffectiveness in the nature of the bite. 
The beak or proboscis of the female mosquito has been 
driven down through the skin until it reached a tiny 
capillary, or blood vessel. Its charge of poison is 
heaviest at the tip, so that the cause of the itching is 
lodged not merely completely under, but a sixteenth 
of an inch below the skin, and as the human skin is al- 
most absolutely water-proof, remedies poured on or 
rubbed over the surface of the bite have very little 
chance of reaching the site of the trouble. Fortun- 
ately, there is one consoling feature about these bites, 



SNAKES IN THE VACATION EDEN 345 

and that is that, intensely irritating and disfiguring 
as they are, they are not in the slightest degree dan- 
gerous to life and health, unless they happen to have 
been produced by a mosquito infected with malaria, 
or yellow fever. The irritation they produce is quite 
short-lived, seldom lasting more than about twenty 
or thirty minutes, except in unusually irritable skins. 
Therefore, any remedy which will relieve this irrita- 
tion, or which will temporarily deaden the nerves of 
the surface of the skin, will be sufficient to "cure." 
The two groups of remedies which will produce the 
greatest relief are usually cooling lotions, especially 
those of alkaline reaction, such as is made of the famil- 
iar household soda, or containing from ten to twenty 
per cent of alcohol, which by its evaporation produces 
a cooling effect; arnica, witch hazel, or camphor, owe 
most of their virtues and healing effects to the small 
percentage of alcohol which they contain. 

The other group are the stronger aromatic oils, or 
the substances extracted from them, such as camphor, 
menthol, oil of cloves, oil of capsicum, which, though 
somewhat irritating, have the power of numbing for a 
time the nerves of the skin when applied to it. One 
of the most effective of these temporary relievers of 
the itching is a combination of either menthol or 
camphor with equal parts of chloral hydrate. This 
can be readily made by rubbing the two together, 
remembering, of course, that chloral hydrate is a 
poison if taken internally in more than quarter tea- 
spoonful doses; but combinations of them have now 
been prepared and are carried in most drug-stores 



346 COMMON DISEASES 

for the temporary relief of rheumatism and neuralgia, 
put up in little lead, or other collapsible metal tubes, 
which can be very readily carried in the pocket upon 
a picnic or camping trip, and a drop or two squeezed 
into the bite. These will often very markedly relieve 
the itching for fifteen or twenty minutes, by which 
time, in most skins, it will have almost subsided; 
although upon some skins they appear to produce 
little or no effect. 

One thing important to be remembered is that al- 
though it does no particular harm to rub the swellings 
caused by the bites, scratching them or rubbing so 
vigorously as to break the surface of the skin ought 
by all means to be avoided, as this opens a tempting 
avenue for infection to any wandering pus germ, or 
often to the little mild irritation germs which dwell 
upon the surface of our skins. The worst results of 
even severe mosquito bites come from secondary in- 
fections of this sort, and are not due to the poison of 
the original bite at all, except in the indirect way that 
this started the scratching that broke the skin. In 
proportion to their extreme annoyance, these bites 
are singularly harmless. Most of the stories told of 
men, or animals, lost in the woods, going mad, or dying 
from the agony of innumerable insect bites, either lack 
confirmation, or are clouded by the fact that in most 
of these instances, starvation, exposure, and in some 
cases, thirst, have also produced their effects. It is, 
however, no very uncommon thing, especially for a 
tenderfoot, on first entering the woods, if he be se- 
verely bitten by either mosquitoes, black flies, or deer 



SNAKES IN THE VACATION EDEN 347 

flies, to be thrown into a state of irritation bordering 
upon mild fever, with headache, and even some swell- 
ing of the glands of the neck. This irritation, however, 
seldom goes further than this, and after a few days he 
either becomes more expert in dodging and fighting, 
or else he becomes, as most of the guides believe, some- 
what acclimated. So that the bites, while they still 
annoy him, no longer produce these unpleasant after- 
effects. 

It may promote our peace of mind somewhat to 
know that outside of the gnat-mosquito family, and 
a few of the biting flies, the great majority of insects 
in our temperate latitudes either do not bite man, or 
produce trifling or insignificant effects if they do. The 
general belief that spiders are exceedingly likely to bite 
is almost entirely without foundation, scarcely a well- 
authenticated instance being on record of a human 
being being bitten by any of our Northern spiders; 
although a few, of course, of the large hunting spiders 
of the tropics and sub-tropics, such as the tarantula, 
may be guilty of this. The famous " tarantelle " and 
other "spider-bite " legends of the folk-stories are pure 
fairy-tales. 

The bites of ants, though annoying, seldom pro- 
duce even swelling or irritation for more than ten or 
fifteen minutes ; while the stings of bees, wasps, and 
hornets, though intensely painful, are not in any way 
dangerous to health or life, unless they should have 
been inflicted in enormous numbers, or upon some of 
the soft parts in or about the mouth, as for instance, 
a wasp taken into the mouth with a bite of fruit, when 



348 COMMON DISEASES 

the swelling it produces may threaten suffocation. The 
bite of ants and the sting of bees and wasps all owe 
their irritation to the same substance — formic acid, 
closely related to the now famous disinfectant, for- 
malin or formaldehyde. Indeed, the name of this lat- 
ter was taken from the Latin formica, an ant. Whether 
this is what gives ants their alleged curative effect 
upon rheumatism, or not, is an open question. But 
certainly, if you got enough of them they would make 
you forget your rheumatism, or any other trouble 
you happen to have, for a few days at least. 

Caterpillars and "worms" of all sorts practically 
never bite human beings. The only way in which they 
cause irritation is that the hairs upon the hairy and 
woolly varieties are often barb-tipped and poisonous, 
and if thrust into the human skin and broken off, will 
sometimes set up a little superficial irritation. It is 
not necessary either to make pets of, or become 
friendly with them on this account; indeed, on general 
principles, it is best to mash them every chance you 
get, on the principle of the famous old schoolmaster, 
who said that "it never did any harm to thrash a boy, 
for if he had n't done something to deserve it, he was 
just going to." Many of them either attack fruit and 
vegetables themselves, or hatch into moths or large flies 
which do enormous damage. So that our natural ten- 
dency to "needlessly set foot upon a worm" is a wise 
one. 



CHAPTER XVII 

INSOMNIA AND INSOMNIACS 

THE choicest gifts of the Gods come unsought, and 
by strange irony of fate, the more eagerly we 
seek them, the more perversely they refuse to come. 
Ninety -nine and nine tenths per cent of the Genus 
Humanum, at a more or less fixed hour in the evening 
of every day, find their limbs relaxing, their breathing 
deepening, and a sensation of drowsiness stealing over 
them. We set no special value upon this drowsiness — 
indeed, at an early stage of our career we are apt to 
bitterly resent it and fight against it with clenched fists 
shoved vigorously into the eyes. Many of us, all our 
lives long, clear through to our second childhood, rather 
dislike the sensation than otherwise and loathe the 
idea of going to bed. But when some night we lay our 
heads upon our pillow and find that instead of dropping 
swiftly off into unconsciousness, we are staring wide- 
eyed into the darkness, one image chasing another 
through our brains with the swiftness of a racing auto- 
mobile, we suddenly discover that we have lost the most 
priceless gift in the world, and are ready to move 
heaven and earth to get it back again. And the more 
eagerly we long for it, the more elaborately we pursue 
it, the more it refuses to come. After a few nights 
of this sort of thing, we give our condition a name and 
say we have insomnia, proudly or panic-strickenly as 



350 COMMON DISEASES 

the case may be, and this drives sleep further than ever 
from our eyelids. 

We recall, or some kind friend reminds us of, stories 
of how criminals are tortured to death in the Orient 
simply by forcibly preventing them from going to sleep, 
or how So-and-So, after walking the floor with insomnia 
for several weeks, broke down and was taken to the 
asylum. We go to bed with the firm conviction that we 
are " not going to get a wink of sleep this night " — and 
then we are insomniacs! 

Sleep is most useful and beneficial, but before we 
resign ourselves to an imminent nervous break-down, 
or a Niagara-like plunge toward an asylum, it is well to 
remember two or three important facts : First, that we 
have no reliable evidence that loss of sleep, however 
prolonged — save by deliberate physical violence, and 
even these instances are little better supported than 
most traveler's tales — ever killed any one, or drove 
them insane. Second, that even in the deepest sleep, 
we never completely lose consciousness, or, to put it 
briefly, we are not asleep all over at once; so that we 
may be conscious of many things that are happening 
about us and yet be soundly and restfully asleep. 
Third, that we vary widely, as individuals, in the actual 
amount of sleep that we require, according to our age, 
the nature of our work, our nutrition, etc. So that it is 
quite possible for a man or woman in a light, unexhaust- 
ing occupation, with abundance of food and good physi- 
cal surroundings, to go for weeks and even months on 
only a few hours' sleep out of the twenty -four. 

Fourth, that ninety-five per cent of all cases of 



INSOMNIA AND INSOMNIACS 351 

insomnia are symptoms of some other form of dis- 
turbance, either of physical health, or of the mind, or 
emotions, from worry, grief, or overstrain, and will 
disappear completely when their cause is removed. 
Get rid of the cause of your worry, or strain, if you 
can; or if not, make up your mind to bear it until the 
merciful forgetfulness which comes with the passage 
of time steals to your relief. 

Correct any bad physical habits you may have got 
into, and trust Nature — she will do the rest. If you 
are giving yourself the chance, the number of hours in 
bed, to take all the eight or nine hours' sleep, which on 
general principles you need, you may rest assured that 
you are getting much more nearly what you need than 
you think you are. 

One of the most curious but cheering things about 
insomnia is, that we know so little about the real nature 
of its opposite — sleep ! All the theories that have 
been advanced as to the causation of sleep have prac- 
tically gone by the board, and our most modern know- 
ledge of it is most exclusively negative. We know 
pretty certainly that it is not due wholly, or even 
chiefly, to the narcotic effect of waste poisons accumu- 
lated in the blood, nor to anoemia, or bloodlessness, of 
the brain; nor to the variations of oxygen and carbon 
dioxide in the body; least of all to darkness and light, 
or food, or work. 

Our study of the habits of animals has given us no 
light upon the subject. Some animals appear to sleep 
the greater part of the time and only wake up to go in 
search of food for themselves or their voung, or in the 



352 COMMON DISEASES 

mating seasons. Some sleep in the day, others in the 
night; it is doubtful whether some, like fishes and frogs, 
ever sleep at all in the true sense of the term, although 
they pass into a state of torpidity in certain seasons of 
the year. The vast majority of us, under average con- 
ditions, require in childhood from ten to twelve hours, 
and in adult life from eight to ten hours of sleep a 
day; and yet, under various circumstances, we have 
extraordinary powers of going for weeks with compara- 
tively few hours out of the twenty -four. 

So if you are keeping fairly close to your average 
weight, have a fair appetite and a good capacity for 
work, there is little need to worry seriously as to 
whether you are getting three, five, or nine hours' 
sleep during the night. Rid yourself of the conviction 
that it is vitally and tremendously important that you 
shall get eight full hours of — if I may use the term — 
conscious sleep every night, and you have taken a long 
step in the direction of getting rid of your insomnia. 

The man who is in greatest danger from sleeplessness 
is the man who sleeps soundly, but who does not allow 
himself a sufficient number of hours in bed. Give your- 
self nine hours of rest in a comfortable bed in a well- 
ventilated room, and you need not be too critical as to 
whether you are convinced that you have spent the 
whole of that time in sleep or not. Every one who has 
suffered from what is ordinarily described as a restless 
night, can recall how much more rested he felt in the 
morning than he expected to feel, unless his rest- 
lessness were due to pain, or discomfort, from some 
definite diseased condition. 



INSOMNIA AND INSOMNIACS 353 

One of the most curious and puzzling things about 
insomnia is the difficulty — I had almost said impossi- 
bility — of determining positively just how many hours 
of the night we actually are asleep, or awake, which- 
ever way you prefer to express it. Much of this diffi- 
culty is inherent, from the fact that naturally we don't 
remember, and have no means of recording, or deter- 
mining, the hours during which we were sound asleep; 
while those in which we were awake stand out clear 
and unforgettable. One extraordinary fact, long ago 
noted in the study of insomnia, is that its victims inva- 
riably sleep much better when they are out of the hear- 
ing of the ticking of a clock, or the striking or tolling of 
a bell, or even when they are simply deprived of their 
watches. In fact, the whimsical paradox has not lacked 
supporters that the prevalence of insomnia in modern 
times is closely associated with the greater commonness 
of clocks and watches. 

One of the most singular and bizarre problems in the 
study of insomnia is that it is possible for a victim to 
have heard the clock on the stairs, or in a neighboring 
tower, strike every hour from eleven to five and yet 
have been asleep nine tenths of the time. This is due 
to the fact, of which dreams and nightmares are vivid 
and commonplace proof, that our loss of consciousness, 
either bodily or mental, in sleep, is never absolutely 
complete. We are never asleep "all over," so to speak. 
In even the deepest slumber, we still respond to im- 
pressions upon all our senses, and in lighter sleep these 
impressions may actually enter into mental conscious- 
ness as well and transform themselves into dreams and 



354 COMMON DISEASES 

memories. As of course every one knows, if a bright 
light is flashed in the face of a sleeper, he will contract 
his eyelids, or move his face away. If a current of cool 
air be fanned against his neck, he will pull up the cover; 
if the sole of his foot is tickled, he will pull it away, or 
lash out vigorously at the disturber. These simple 
muscular responses are taken most despicable advan- 
tage of by one of the expert schools of professional 
thieves in the Orient who, by gently breathing in 
their victim's face, or by tickling his hands or feet, or 
lifting one side of his bed or mattress and depressing 
the other, will cause him to roll over in any direction 
that they desire, rob him not only of what may lie 
under his pillow, but of the blanket in which he has 
rolled himself up, or the rug on which he is lying; and 
by gently breathing upon his flesh as it is exposed, to 
prevent its chilling, will even strip him of every article 
of clothing that he has on, without ever waking him 
up. Words whispered into a sleeper's ear persistently, 
will sometimes be repeated by him; sensations experi- 
enced during the night will change themselves into 
dreams, as of fighting, or being choked by some antago- 
nist, or by a snake, because of an accumulation of gas 
in the stomach; dreams of Arctic Relief Expeditions, 
on a chilly night, or because of the falling off of the 
blankets; dreams of fireworks, because of a light shin- 
ing in the face, and so on. 

Another illustration of the persistence of the higher 
consciousness in sleep is in the power which most of us 
possess of waking up at, or near, a certain hour, by 
merely making up our minds to do so when we retire. 



INSOMNIA AND INSOMNIACS 355 

If we are within hearing of the striking of a clock, this 
is a comparatively simple matter and our waking will 
even be timed with a singular degree of accuracy. But 
even where we have not this exterior aid, we seem to 
possess some crude measure, or estimate, of the pas- 
sage of time, although if we will watch closely and dis- 
passionately, we will find that our waking at a certain 
hour is usually achieved chiefly by dint of waking up 
at frequent intervals all through the night, until finally 
the desired hour arrives and we get up. 

It is a comparatively simple feat for the chronic 
insomniac after he has heard the clock strike two or 
three times and got, as it were, into his chronological 
stride, to either wake up at the expiration of each hour 
in time to hear it strike, or come so near the surface of 
wakefulness as to be awakened by its first stroke and 
count the remainder. 

A similar " checking " process upon noises and sounds 
has of course long been familiar in the opposite direc- 
tion, so to speak — namely, that where we have become 
accustomed to a constant, persistent sound, such as 
the noise of a mill, or the running of an engine, or the 
chugging of the screw on an Atlantic liner, the instant 
that this stops, we wake up at once. It is highly prob- 
able that our well-known inability to sleep well and 
soundly the first night in a strange room, or a new bed, 
is due not only to the presence of unfamiliar sounds, 
jars, lights, and other sensations, but also to the ab- 
sence of the familiar sounds which have become, as it 
were, the sub-stratum of our sleeping consciousness. 
It is no uncommon experience for city dwellers to be 



356 COMMON DISEASES 

unable to sleep well during their first night or two in 
the country, on account, as they whimsically express 
it, of the "awful and noisy silence." And a like experi- 
ence is not unknown among campers, or hunters, the 
first night or two out in the eerie stillness of the woods. 

Instances are even recorded where individuals sleep- 
ing near a railroad line on which one or more night 
expresses thundered past at fixed and regular hours, 
would pay no attention whatever to the train if it came 
on, or within twenty minutes of, time, but would be 
awakened promptly if it were more than half an hour 
late. 

So one thing you may feel fairly sure of, and that is, 
however positive you may be that you have not slept a 
wink all night, or that you have heard every hour, or 
every quarter, strike from ten to six, if you have been 
resting quietly between the sheets without positive 
discomfort of any sort and without getting up and pac- 
ing the floor, or reading, or doing something definitely 
active, you have been getting a great deal more sleep 
than you think you have, and probably nearly as much 
as you require. Insomniacs should adopt something of 
the cheerful philosophy of Colonel Carter of Kentucky 
who, on one of his visits North, was asked by a neuras- 
thenic friend, who was impressed by his cheerful and 
care-free appearance, how he managed to sleep so well 
every night. 

" My dear suh," said the Colonel, " I nevah have any 
trouble about that. I just take a nightcap of two fingers 
of the best rye whiskey every night, just before going 
to bed, and I sleep like a child till daylight. If I don't 



INSOMNIA AND INSOMNIACS 357 

get to sleep right away, I get up and take two more 
fingers of whiskey." 

"Well, but," persisted the anxious one, "supposing 
that does n't put you to sleep, what do you do? " 

"Well, suh, I just go over to the dresser and I take 
four fingers of whiskey." 

" But if that should n't put you to sleep? " 

" Why, suh by that time I don't care a d — n whether 
I ever get to sleep or not." 

Insomnia is both a penalty and a pathologic luxury 
of civilization. It is a mark of neurologic aristocracy, 
'as distinctly and unquestionably as gout is a mark of 
blue blood and ancient lineage. Those who possess it 
may be as vain of it as of a coronet on their note-paper. 
The great mass of mankind seldom suffer from in- 
somnia — they have too many other troubles. 

To hear an insomniac recite his woes as he holds 
you with his glittering eye, one would think that to lie 
awake two or three hours in a comfortable bed, listen- 
ing to the clock as it strikes was one of the deadliest 
diseases that afflicted humanity; and night-long sleepy - 
headedness the most precious and vital privilege of 
man. 

As a matter of fact, insomnia, like the devil, is not 
so black as it is painted. It is n't the staying awake for 
an hour or two at night that 's abnormal, so much as the 
worrying about it all the next day. Most of us in our 
salad days — and in later life, while healthy and vig- 
orous — think little of losing not merely an hour's but a 
night's sleep. We echo the gay philosophy of Tom 
Moore that — 



358 COMMON DISEASES 

" The best of all ways to lengthen our days 
Is to steal a few hours from the night." 

It is a reckless and easy-going philosophy, but it has 
some justification in the ease with which deprivations 
of this sort can be made good the following night, so 
long as the beautiful elasticity of youth lasts, and the 
rigidity of advancing years draws not nigh. 

Nor did the childhood of the world worry itself much 
about insomnia, for the reason that it had such unlim- 
ited opportunities of making up for the loss, and so 
comparatively little to keep it awake at night — or in 
the day-time, either. It also retained some of the old- 
time power of hibernation, which enabled it to drop 
peacefully off to sleep, in order to fill up the time, when 
it had nothing else to do. Its principal objection to 
lying awake at night was on account of the things 
which one might happen to see in the interval — 
things that flapped and glared at the windows, or stood 
rigid and terrible at the head of your bed, and would 
"git you" if you did n't pull the blankets over your 
head. Perhaps part of the violent objection that we 
have to lying awake at night is a survival, a vague and 
indefinable fear that some of these bogies of the nursery 
days of our minds may reappear. 

All the protections and safeguards of twenty centu- 
ries of civilization seem to drop away from us, and leave 
us naked and unprotected to our enemies, when we 
wake "in the dim and dead of night, when the rain is 
on the roof." Every sound must be explained and 
strictly accounted for. It is probably only a rat, or the 
wind rattling the windows, but it may be a jabber- 



INSOMNIA AND INSOMNIACS 359 

wock, or a burglar ! Every moving shadow reveals an 
enemy with drawn, uplifted knife; every point of light 
is the gleaming eyeball of some jungle beast. This is 
the hour when the gods were born, when even the bold- 
est must have someone to appeal to for protection. If 
we were quite sure that nothing terrible would happen 
to us during our hours of wakefulness, perhaps we 
should not dread insomnia so much. 

Of course, to lose two hours of sleep, out of our neces- 
sary eight, is both unpleasant and unwholesome — 
like being robbed of one fourth of our proper supply of 
food. If it were to continue indefinitely, it would ulti- 
mately result in physical bankruptcy. But the human 
mechanism is astonishingly elastic. It can allow itself a 
surprising amount of leeway, and yet keep safely on its 
course. If you give yourself nine hours in bed every 
night, nothing is easier than for the body to make good 
its deficit at any time, almost without your noticing it. 
The mere fact that you lay awake two hours last night 
and three hours the night before is no proof that the 
same thing is going to repeat itself every night for the 
next month. Indeed, not more than one case of insom- 
nia in fifty ever continues so long, or so constantly, as 
to cause the health to suffer appreciably from actual 
loss of sleep. 

Unless there is some positive disease of body or some 
serious disturbance of mind, the more sleep you lose for 
two or three nights in succession, the more likely you 
are to make it up in the next three or four nights. Na- 
ture is perpetually redressing the sleep balance, with- 
out your being aware of what she is doing. We can 



360 COMMON DISEASES 

readily tell when we eat, and how much we eat, but no 
man living can say positively when or how long he is 
asleep. It is only the time when he is awake that he can 
testify to with certainty; and his senses may grossly 
deceive him even as to that. 

The gravity of both sleeplessness and loss of appe- 
tite depends almost entirely upon the seriousness and 
obstinacy of their cause. So far as the actual loss of 
food or sleep is concerned, the human body has almost 
incredible powers of enduring both starvation and 
wakefulness without serious or permanent injury. 
Remember that the strongest and most unconquerable 
tendency of a normal individual is to sleep when 
he is tired and eat when his stomach is empty; and 
that it takes some positive and persistent obstacle 
to prevent him from indulging in either of these vital 
habits. 

When your tissues get to a point where they really 
need and demand sleep, you could not stay awake if 
someone stood over you with a drawn sword. Remove 
the cause of your insomnia, and sleep will follow as cer- 
tainly as the night the day. If this cause be a definite 
or organic disease, then the gravity of your insomnia 
will be the gravity and obduracy of this particular 
disease. If it be due to some form of grief, or bereave- 
ment, you may rest assured that sooner or later you 
will fall into the heavy, dreamless sleep of exhaustion, 
or that the deadening effect of the passage of time will 
dull the edge of your agony. 

The cheering thing to remember, in insomnia, is that 
in nine cases out of ten the cause is either completely 



INSOMNIA AND INSOMNIACS 361 

removable, or will mitigate itself gradually with the 
merciful oblivion of time. 

Insomnia is always a symptom of some physical 
disturbance or mental strain, and ought by no means 
to be ignored or lightly regarded. It is, in fact, one of 
our most invaluable danger-signals, the prompt heed- 
ing of which will save us many a breakdown. Yet the 
thing to be borne clearly in mind is its curious power of 
self-exaggeration, its tendency to make us overesti- 
mate both the amount of our wakefulness and the seri- 
ousness of the results which are likely to follow from it. 

There are forms of insomnia which are the first sign 
of physical breakdown, or mental unbalance; and 
though these do not form more than one per cent — 
scarcely more than one in five hundred — of all cases, 
the impression, unfortunately, seems to have got 
abroad that all forms of insomnia tend to carry their 
victims in this direction, and will inevitably end in 
some catastrophe, unless checked. As a matter of fact, 
even the ten per cent of cases which are not due to some 
temporary or readily removable cause, and which tend 
to persist in milder or severer form, in spite of all that 
can be done for them — even these might in the vast 
majority of instances, run unchanged for months, and 
even years, without seriously or permanently under- 
mining the health. 

But of course you cannot make anybody who has 
insomnia believe this ! That is one of the fundamental 
symptoms of his condition. In spite of the best and 
coolest judgment which he can bring to bear upon 
his condition, he will die, and nobody shall save him, 



362 COMMON DISEASES 

unless this terrible and intolerable loss of sleep is 
stopped ! — 

He is the best illustration possible of the homely old 
distich: — 

"A man convinced against his will 
Is of the same opinion still." 

And the difficulties of convincing him are fundamen- 
tal and peculiar. First and foremost, to prove to a man 
that he is asleep is like attempting to prove a negative, 
only more so. No one knows when, or how long, he is 
asleep. He only knows what his last memories were on 
dozing off, and what time it was when he awoke. The 
playful little agreement that we used to make in the 
happy days of childhood, when we slept three or four 
in a room, that the one who fell asleep first would 
whistle, was never yet fulfilled. Unless some genius 
can invent a paradoxical sort of a clock that we can 
hear when we are asleep and cannot hear when we are 
awake, we shall never be able to demonstrate posi- 
tively the exact amount of our slumbers or of our 
wakefulness. 

How difficult it is to make any one who is skeptical 
on the subject believe that he has been asleep is amus- 
ingly illustrated by a story told by an eminent physi- 
cian of the experiments with laughing gas, in the early 
days of its use. 

Its inhalation became one of the popular fads, and 
young people at evening parties would amuse them- 
selves by getting some doctor friend to give laughing 
gas to three or four of their number, and watching the 
result. On one of these occasions, the gas was admin- 



INSOMNIA AND INSOMNIACS 363 

istered to a young lady and two young men, all of 
whom went soundly to sleep, and woke up again in a 
few minutes. Two of them admitted the success of the 
experiment, but the third — a particularly pig-headed 
young fellow — insisted that he had never been asleep 
at all, but had just been pretending; and had heard 
every word of what had been said while he was sup- 
posed to be unconscious. 

For several minutes they argued with him without 
avail, and then one of the young ladies with a mis- 
chievous smile whispered something in the ear of the 
doctor. The doctor turned to the skeptic and said : — 

"Well now, Mr. Smith, perhaps that time it was not 
a success. Suppose we try it again!" 

To this the doubter readily consented. When he 
was fully under the influence, the doctor told one of his 
friends to remove his shoes and stockings. To the 
intense amusement of everybody in the room, the 
young fellow was evidently in the frame of mind of the 
lady from the rural districts who, on seeing a porcelain 
bath-tub for the first time, declared that it looked so 
good that she could hardly wait until Saturday night 
to try it — and it was late on Friday in his calendar. 

As soon as he regained consciousness, he again began 
protesting that he had never been asleep, had just 
wanted to fool them, and so forth; but his protesta- 
tions were quickly cut short by the doctor's quietly 
smiling and pointing to his feet. The youth made one 
wild grab for his shoes and stockings, bolted precipi- 
tately from the room, and never made any further 
attempt to deny that he had been sound asleep. 



364 COMMON DISEASES 

Naturally, no one can remember anything about the 
time when he was actually asleep, though the hours 
during which he was awake stand out vividly and con- 
vincingly. This is not to say, of course, that many 
individuals do not suffer both in their comfort and in 
their health from chronic and persistent loss of sleep, 
but only that the amount lost, and the damage done 
thereby, is never as great as it appears to the sufferers. 

Another of the psychic characteristics of insomnia is 
that it seems to fill its victims with a sort of morbid 
pride in their martyrdom. "Woe be unto them if they 
preach not the gospel of sleeplessness." They seem to 
be seized with a positive cacoethes loquendi, an over- 
whelming impulse to talk about their experiences. If 
they happen to be gifted with the pen, they write es- 
says about the subject, like De Quincey and Stevenson. 
If they are musicians they compose etudes to express 
their sensations, like Heller's "Nuits Blanches/' If 
they are simply private citizens, they talk about their 
symptoms over their teacups, or their steins, until one 
imagines that the whole round world is full of the 
victims of insomnia. 

As a matter of fact, obstinate and serious forms of 
the disease are far from common; and the average 
family physician is not called upon to prescribe for 
sleeplessness half as often as is popularly believed. 
One good, wide-awake case of insomnia, determined to 
get something to put him, or her, to sleep, will go the 
rounds of every doctor in town and multiply his appar- 
ent numerousness tenfold. 

Whether it is or is not becoming more common than 



INSOMNIA AND INSOMNIACS 365 

formerly, it is difficult to say; but there appears to be 
little evidence in support of the popular belief in its 
greater prevalence, save in the sense that we are becom- 
ing more sensitive to lighter ailments and demanding 
higher standards of health and comfort than formerly. 

One form of insomnia consists chiefly of a luckless 
sort of split in our consciousness, which keeps one cor- 
ner of the mind awake to see whether the rest of it is 
asleep or not, and to report in the morning. That the 
consciousness of many insomniacs is playing them this 
curious trick is abundantly proven by the test of direct 
observation. 

The great majority of sufferers from insomnia are, 
of course, not sick enough to go to a hospital, or even 
to have a nurse. Sometimes, however, they are in- 
duced to enter a sanitarium; and when the night nurse, 
as a means of determining the severity of their trouble, 
is ordered to include them in her rounds and look in on 
them at regular intervals, three times out of four, how- 
ever loud their protestations of never closing an eye 
all night, they are found sleeping soundly, and even 
snoring. 

Another proof of the unreal character of many cases 
of insomnia is the readiness with which they yield to 
suggestion, or some other form of mental treatment. 
Naturally, that which exists chiefly in the mind can be 
cured by the mind. Neurologists, or specialists in 
nervous diseases, into whose hands these sufferers 
usually fall sooner or later, have reported brilliant suc- 
cesses in cases that had defied every other form of 
treatment, by first telling the patient what wonderful 



366 COMMON DISEASES 

results had been obtained by this method, and what 
influence the mind had over disease; and then by 
directing him to repeat once or twice an hour, all 
through the day : — 

"I am going to have a good night's sleep. To-night 
I am going to sleep like a top. I shall have a bully 
night's rest!" 

The sufferer is ordered to repeat the same formula 
if he happens to wake in the night, and to keep on 
repeating it until he falls asleep again. In addition, a 
card with the cheering words printed upon it is hung 
over his dressing-table, where he can let his eyes rest 
upon it the last thing before he closes them upon the 
pillow. In a short time the patient becomes mildly 
self -hypnotized. He drops the bad mental habit of 
taking his own sleep-pulse, as it were, and listening for 
the clock to strike all night long. He begins to believe 
he is getting the better of his trouble, instead of its 
mastering him; and in a few weeks he is convinced that 
he is sleeping soundly nine tenths of the night — 
which has been the fact from the beginning. This is 
a fair example of the way in which hypnotism and 
suggestion usually "cure" in medicine. 

Although insomnia is not going to drive us, either as 
individuals or as a race, into nervous bankruptcy, yet 
it is a very real and troublesome affliction, which at- 
tacks many of us occasionally, and some of us fre- 
quently. The interesting question is, as ever, the 
practical one — what are we going to do about it? 

The first thing to get clearly in mind is that sleep- 
lessness is usually as easily curable as it is common; 



INSOMNIA AND INSOMNIACS 367 

and that even those cases which prove obstinate, and 
resist our best endeavors, can almost invariably be 
brought within such limits as will not seriously inter- 
fere with either comfort or efficiency. The whole in- 
terest and practical importance of the problem centre 
not in the fact that you don't sleep, but in the question 
why you don't. 

Paradoxical as it may sound, many persons are un- 
able to sleep well because they are too tired. They 
have driven themselves so incessantly, day in and day 
out, fifty-two weeks out of the year, in one rut and one 
mill-horse round, and their brains are so loaded with 
fatigue toxins, that they fall into a sort of waking deli- 
rium. All night they keep on thinking round and round 
and round in the same circles they have been following 
during the day, until they are ready to drop dead, like 
stampeded cattle or Marathon racers. 

To imagine that the peaceful stillness of the country 
will make you sleep, when the whole cyclone of the city 
is roaring and raging in your brain, is simply ludicrous. 
If you can't sleep, it is a sign for you to make a change 
of hours — or jobs ! To do anything, or take anything, 
at night to make yourself sleep is like locking the 
stable-door after the horse is stolen. To your tired 
nervous system, it adds insult to injury. Warmth to 
the feet, or cold to the head, or reciting the Declaration 
of Independence, is like trying to break a log-jam with 
a tooth-pick. 

It must not be forgotten that a small group of in- 
somniacs suffer for just the opposite reason — because 
they are never sufficiently wide awake in the daytime, 



368 COMMON DISEASES 

in any intelligent sense, to notice the difference when 
they go to sleep. People who have little to do, and few 
real interests in life, often sleep just about as badly as 
they do everything else. In these cases, the best cure 
is to get something to do that will really wake the 
patient up in the daytime. 

Others imagine themselves in danger of becoming 
nervous wrecks because they can't fill up with sleep all 
the time they have to waste in the twenty-four hours. 
One of my colleagues, some years ago, told me that he 
had been consulted by a lady of his acquaintance, who 
came into his office looking the very picture of flabby 
woe. 

"Oh, doctor," she said, "what ever shall I do? I 
can't get a wink of sleep after four o'clock in the 
morning, and I'm becoming a nervous wreck! " 

The patient was a stout, comfortable-looking young 
married woman, of well-to-do family, and living under 
most favorable physical conditions. The doctor took 
her pulse, looked at her tongue, sounded her chest, 
made inquiries as to her digestion, her appetite, her 
household cares and other duties. Everything ap- 
peared to be perfectly normal and healthy. She suf- 
fered no pain, she had no sign of any organic disease. 
There was nothing in her financial or domestic cir- 
cumstances to worry her in the slightest — she just 
simply woke up about four o'clock every morning, and 
tossed about wide-eyed until breakfast time. 

The doctor was beginning to feel nonplussed; finally 
it occurred to him to inquire as to her hours of retiring. 

"Oh, I'm always very particular about that, doctor. 



INSOMNIA AND INSOMNIACS 369 

I am very regular about going to bed. It 's very, very 
seldom that I 'm not in bed and asleep by eight o'clock." 

This "nervous wreck" had had eight hours of sound 
sleep before her "insomnia" began to torture her! 

One of the commonest, if not the commonest, single 
cause of restlessness at night is an insufficient amount 
of exercise in the open air during the day. Sleep is far 
more a matter of the muscles than of the brain; and if 
you work during the day entirely with the latter, the 
chances are decidedly in favor of some angle or corner 
of it lying awake, either to dream, or to bother you 
with hard-luck stories in the morning. Get yourself 
thoroughly and comfortably tired at some form of 
pleasant exercise in the open air — walking, riding, 
ball-playing, tennis, rowing, fishing, gardening, danc- 
ing, automobiling — no matter what, so long as it 
keeps you interested, under the open sky; and you 
have pretty nearly insured a fair night's rest. 

The next commonest cause is lack of drafts in the 
bedroom. I say drafts advisedly, for the only air really 
fit to breathe is air which is in motion; and every bed- 
room should be so arranged that a steady current of 
air flows through it gently all night long. It won't hurt 
you a particle to lie right in that current, simply 
putting on blankets in proportion to its coolness or 
coldness. 

The ideal place to sleep is on a porch, or a roof; and 
the bedroom of the future will consist of a good-sized 
sleeping-porch, sheltered by curtains which can be 
drawn on the stormy side, with a small dressing-room 
attached to it. This, even in our northern climate, can 



370 COMMON DISEASES 

be slept in, not merely without discomfort, but with 
actual delight, three hundred and thirty nights out of 
the year. 

Another thing to be avoided by those inclined to 
sleeplessness is going to bed with too empty a stomach. 
The popular prejudice against going to bed on a full 
stomach appears to have surprisingly little rational 
foundation. Children, the sweetness of whose sleep is 
proverbial, almost habitually fall asleep over their 
suppers; and animals and savages lie down and snore 
the clock round, directly after not merely a full meal, 
but, in the language of the mining-camps, a "puffiek 
gorge." When more than four or five hours have 
elapsed since dinner or supper, it is often helpful to 
take a handful of crackers, a glass of milk, or a cup of 
oyster soup, or beef tea just before retiring, if you are 
inclined to be restless. 

In the sweat of thy brow shalt thou earn sleep, to 
paraphrase Scripture, and a good, free perspiration 
honestly earned and produced is the best known hyp- 
notic. For those who are too lazy, or whose duties are 
too confining, to allow them to get this, a hot bath just 
before retiring will prove helpful. But it is a poor 
substitute for the real thing; and on general principles, 
it is a hard thing to keep healthy without at least one 
good sweat every day. If the weather happens to be 
hot, a cool bath just before retiring will be a great help 
toward a restful night, because of its soothing effect 
upon the nervous system. 

When you actually find yourself sleepless, the best 
thing to do, at that particular time, is nothing whatever; 



INSOMNIA AND INSOMNIACS 371 

and the more thoroughly and completely you do it, the 
better. Just make up your mind what you are going 
to do next day to prevent a repetition to-morrow night, 
and resign yourself to the situation. Remember, it 
won't do you the slightest harm in the world to lie 
awake in a comfortable bed, in a well- ventilated room, 
for one, two, or even three hours at a stretch, provided 
you keep your muscles quiet and your mind at rest. 

If your mind wants to think, let it. It won't do you 
any harm, and there are few of us who do too much of 
that useful process during our waking hours. Just try 
to turn it into interesting, profitable, and entertaining 
directions. The man or woman who cannot enjoy a 
couple of hours with his or her own thoughts has sadly 
wasted his opportunities. 

If your thoughts want to tear all over the known 
world, don't try to stop them; the farther and faster 
they travel, the sooner they will tire themselves out. 
If you can only forget that you are awake, you will be 
asleep before you know it. If you are thirsty go and 
get a drink; if the room has become stuffy, throw the 
windows wider open; if your feet have become cold in 
any way, do whatever is necessary to get them warm. 
But beyond this, avoid anything which lifts your head 
from its pillow. One of my colleagues — a man of wide 
experience and national reputation — used to say to 
his patients who complained of sleeplessness : — 

"Lie quietly in bed in good air all night long, and I 
don't care whether you get to sleep at all or not." 

Anything which concentrates your attention upon 
the fact that you are awake and sleepless simply makes 



372 COMMON DISEASES 

matters worse. This is particularly true of such hoary 
old humbugs as repeating the multiplication-table up 
to twelve times twelve, or counting imaginary sheep 
jumping through a hypothetical gap. Any individual 
who can be allowed at large without a guardian can 
find some more interesting and profitable occupation 
for his wakeful hours than these infantilities. Instead 
of putting you to sleep, they merely convince you, 
beyond possibility of doubt, that you are widely and 
hopelessly awake. 

It is not best, even for those who are inclined to be 
poor sleepers, to be too fussy and particular about ab- 
solute freedom from noise and absolute absence of light 
from their bedrooms. In fact, attempts to darken a 
room by means of blinds and curtains, render it diffi- 
cult to ventilate properly. Make up your mind that 
you are going to sleep with every window in your room 
open, and every blind run up to the top, and you will 
find that you will get more hours of sleep, and far more 
benefit from the hours that you do get, than by stifling 
yourself behind pulled-down blinds and drawn curtains. 

As a matter of fact, most of us sleep quite as well in 
a room which is simply as dark as the night without, 
and where, as occurs everywhere except in the remot- 
est depths of the country, there is a certain amount of 
moderate noise going on perpetually, as we could do 
in chambers as dark as a cave and as still as the tomb. 
If you find that the starlight, or moonlight, or even 
the rays of a street lamp coming through your window, 
annoy you, don't fuss about the light, but take an 
hour more exercise next day. 



INSOMNIA AND INSOMNIACS 373 

As for drugs to produce sleep, they can only be men- 
tioned to be utterly condemned. First, because, even 
at their best, they merely smother a symptom with- 
out doing anything to relieve its cause; and second, 
because, without exception, all that have any real ef- 
fect are narcotic poisons, and dangerous ones at that. 

The only drugs which will produce sleep without 
doing harm are such drugs as may relieve pain or re- 
move the cause of the sleeplessness. Except in case 
of acute pain, or organic disease, the causes of sleep- 
lessness are far better removed by exercise, bathing, 
fresh air, and change of scene or occupation, than by 
any drugs. 

It is hardly too much to say that those who suffer 
from insomnia suffer more from the way in which they 
worry over their sleeplessness, and from the drugs 
they take to relieve it, than from the actual loss of 
sleep. 

Every one of the much- vaunted and much-adver- 
tised "harmless" hypnotics, or sleep-producers, be- 
longs to the great methane group, of which chloro- 
form and chloral are the best-known members. Like 
all narcotics, as the system becomes habituated to 
them, the dose must be increased in order to produce 
the effect. Though relatively harmless in small doses, 
they create a craving, and there is great danger that 
sooner or later a dangerously large dose will be reached. 

The habitual chloral-taker often ends by taking a 
dose from which he never wakes up. Emphatically, 
the remedy is worse than the disease ! 

The insomniac often suffers from a sort of unfortu- 



374 COMMON DISEASES 

nate split in his consciousness, by which one little cor- 
ner of his mind stays awake to see whether the rest 
of it is asleep or not. 

It goes without saying, that the chronic insomniac 
really is definitely and physically ill; that this annoy- 
ing dissociation of consciousness would not take place 
in a perfectly normal individual under ideal surround- 
ings. The encouraging thing is that he is not nearly so 
sick as he thinks he is. In fact, with the exception of 
a few unfortunate cases already referred to, in which 
insomnia is one of the earlier symptoms of organic 
brain, or mental, disease, which scarcely form one per 
cent of all cases, the average sufferer from insomnia 
will either recover within a few weeks, when the dis- 
turbing physical or mental cause is removed, or miti- 
gated; or will go on suffering from occasional restless 
nights for twenty, thirty, or fifty years without being 
a hair the worse for it. Certain forms of insomnia, in 
fact, are like sick headache, neurasthenia and certain 
mild types of asthma — a sort of advance guarantee 
of a long and active, if somewhat checkered and storm- 
tossed, life. The highest mortality from insomnia 
occurs not in the victims themselves, but in the mem- 
bers of their family — and their physicians. 

This curious habit of sleeping, as it were, in sections, 
while usually the result of a morbid condition of body 
or nerves, may be acquired by persistent effort by 
perfectly normal individuals. Several physiologists 
and psychologists who were engaged in a careful in- 
vestigation of the nature of sleep, found by experi- 
ments upon themselves that they could so divide their 



INSOMNIA AND INSOMNIACS 375 

consciousness as to be able literally to watch them- 
selves going to sleep, remaining perfectly conscious of 
the fact that their eyes were closed, that they were 
breathing deeply, that their muscles had relaxed, and 
even that they were beginning to dream, for as much 
as twenty, or thirty minutes at a stretch ; during which 
time they were able to wake themselves up at will. 

To put it broadly, the vast majority of all cases of 
insomnia are merely temporary disturbances due to 
some disorder of body, or distress of mind, and will 
disappear when their cause has been removed or the 
system has become adjusted to the new situation. A 
moderate minority, and these far the most troublesome 
and persistent cases, are due to some unfavorable con- 
dition of mind or body acting upon a nervous system 
already predisposed to these curious dislocations and 
other forms of disturbance. This form of insomnia, 
for instance, is very apt to run in families and to occur 
in those already of the so-called neurotic, or nervous 
type. It is a troublesome condition in the sense of be- 
ing difficult to completely check, and apt to recur; but 
it has the encouraging side of seldom being as bad as it 
appears to be, of being able to last for a long period 
without seriously injuring the health of the victim, 
and of usually, in the long run, gradually subsiding, 
or becoming so mild as to cause little further distress 
either bodily or mental. Lastly, a very small fraction 
of all cases are the early signs of serious nervous or 
mental disease. 

Now supposing you are troubled with sleeplessness, 
what is your plan of campaign? The first thing to be 



376 COMMON DISEASES 

borne clearly in mind is that the really important 
thing is not the restlessness, or the loss of sleep, but 
the condition or influence that causes it. Look for this 
cause and if it be a temporary or comparatively trivial 
one, — as it will be in nine cases out of ten, — remove 
that, and your sleeplessness will disappear like magic. 
Remember, the more you attempt to treat the sleep- 
lessness directly, the worse it will get; and the sooner 
some corner or other of your mind will get into the 
bad habit of sitting up at night to listen to the clock 
strike, and then telling you about it in the morning. 
Go over yourself and habits thoroughly and con- 
scientiously, and in the light of your best judgment, 
make up your mind what you are doing that you 
ought not to do, or leaving undone which you ought 
to have done; then proceed to reform yourself. If this 
fails, go to your doctor and have him go over you 
thoroughly and give you the benefit of his judgment. 



CHAPTER XVIII 

IMAGINARY DISEASES AND THEIR INVENTORS 

WE have all smiled scores of times in a superior 
and pitying way at the imaginary invalid, the 
individual who enjoys ill health and revels in symp- 
toms. Of course, we should never be so foolish, and 
we wonder how any one in his senses can ever desire to 
imagine himself sick when he is well, or take pleasure 
in exaggerating his symptoms if he is ill. And yet we 
all do it at one time or another. 

Self-pity is one of the greatest luxuries on earth, and 
there are few enjoyments keener than inducing others 
to share it with us. Even those hard-faced and stoical 
individuals who make it their boast that they never 
complain, that nobody ever heard them whimper even 
when they were half dead, as a matter of fact, are the 
biggest humbugs of the whole lot, and are inviting 
sympathy by the very vigor of their protestations that 
they never need any and would n't take it if it were 
offered. 

We have an astonishing capacity for harmless and 
consoling little self-delusions. We can live threescore 
years and ten on this planet and yet carry to our graves 
intact the pleasing belief, down in our heart of hearts, 
that we really are a little different from anybody else 
that walks upon the face of the earth; and probably, 
if we were perfectly frank, we should admit with re- 



378 COMMON DISEASES 

luctance that the clay which was used in our making 
was a little finer quality of alumino-silicic oxide than 
that used for the ruck of humanity. Moreover, no- 
body else has quite so handsome a wife or such brilliant 
children or so fast a horse or so good a well. And na- 
turally, when we are sick, no one else suffers quite as 
we do or can appreciate the tortures that we are un- 
dergoing, even though we give no sign. 

For the most part, this robust and romantic self- 
love is perfectly harmless, and one of the greatest and 
most constant sources of pleasure in life — a truly 
golden delusion. But, when it comes to its activities 
in illness, then it turns upon its creator and exagger- 
ates the very sufferings which it is endeavoring to 
soothe. Not that it does any particular harm, except 
in a subjective way; for its effects, like its origin, are 
purely mental, and it can neither make a real disease 
any worse, nor can it under any circumstances origin- 
ate a disease where none existed. 

The imagination may magnify the sufferings of a 
particular illness and increase the length of time that 
the victim will imagine himself or herself sick, and it 
can, of course, inflict frightful amounts of discomfort 
and distress upon the members of their families, but it 
seldom or never goes beyond this. One can no more 
imagine himself into a serious illness than he can, by 
taking thought, add a cubit to his stature. 

One consideration should always be allowed to tem- 
per either our mirth or our indignation in dealing with 
these poor malades imaginaires; and that is, that every 
one of them really is sick, if only ever so little. They 



IMAGINARY DISEASES 379 

may not be one tenth so sick as they think they are, 
and their disease may be as different as the poles from 
that which they are proud to boast it is, but they 
actually are diseased in some respect or they would 
neither invent nor persist in these singular delusions. 

To say that they are "merely hysterical" does not 
help the matter in the least in the direction of explana- 
tion; for we are utterly in the dark as to what hysteria 
means, except that it is a group of symptoms that never 
appear in a perfectly healthy individual. 

Many of these conditions can actually be recognized 
as mild forms of mental disturbance. Such, for in- 
stance, were the patient invalids and pious sufferers 
who filled the Sunday-school literature and the books 

of devotion of a bygone generation. Their principal 

« 

defect was a boundless self-esteem bordering upon 
megalomania, accompanied by a placid indifference to 
the suffering and discomfort that they might inflict 
upon others. 

I well remember in the early days of my practice one 
good mother of this type, who had developed at about 
forty years of age a mysterious and incurable spinal 
complaint. This gradually crippled her inch by inch, 
inflicting excruciating tortures, her irrepressible groans 
of anguish under which could be heard half a mile 
away, until, finally, she became unable to move hand 
or foot and was confined to her room for six years. 

Her piety was most exemplary. Being unable to 
attend the public means of grace, special sessions and 
prayer meetings were held regularly in her room, and 
she was looked upon as one of the pillars of the church. 



380 COMMON DISEASES 

One of the most agonizing symptoms of her disease 
was that, while it left her comparatively free from pain 
during the day, it invariably woke up toward evening 
and caused her to suffer the tortures of the damned all 
night. The only relief that she could obtain, and that 
of a most trivially partial character, came from being 
rubbed incessantly, for hours at a stretch, by her hus- 
band or daughters, one of whom had to be in constant 
attendance upon her nearly all night long. Enthusias- 
tic revivalists had attempted time after time to heal 
her by prayer, but their efforts were unsuccessful. 
Satan was too strong for them. She must be tortured 
to show the power of sustaining grace. 

One day the nearest neighbor, a quarter of a mile 
away, was astonished to see this hopeless paralytic 
rush wildly into his house, exclaiming, "Hurry, Mr. 
Johnson; our house is on fire!" 

It appeared that during the absence of all the rest 
of the family some clothing left to dry near the kitchen 
stove had caught fire, and when the helpless invalid 
smelled the smoke and saw the flames come rushing 
up the stairway, she jumped out of the window on to 
the porch roof and slid down one of the pillars. Need- 
less to say, her cure was permanent. She never could 
fool that family or that neighborhood any more. 

It afterward turned out that at such intervals of 
the night-watches as she was not requiring rubbing by 
some member of her family, she had been in the habit 
of perambulating about the house, helping herself to 
what she wanted in the pantry, and had even started 
the report of "hants" in the house to account for some 



IMAGINARY DISEASES 381 

mysterious noises which excited the curiosity of the 
family. 

It may be mentioned in passing that it has become 
an axiomatic rule with physicians for some years 
past, whenever a report of a certain house being 
haunted is started, to look for some hysterical girl or 
imaginary invalid in the family. They are the real 
Women in White, the sheeted figures that come sweep- 
ing along dark passageways at gruesome hours of the 
night. 

But the things that people will invent about them- 
selves in their excess of self-pity and self-sy mpathy ! 
The popular impression that imaginary diseases are 
chiefly products of the higher civilization and con- 
fined to the wealthier classes who have leisure to be 
sick — those who suffer, as they say of the tourists in 
California, from "nervous prosperity" — is entirely 
mistaken. 

The most persistent and grotesque morbid fancies 
are to be found among the poorest and most ignorant. 
Nothing, for instance, is commoner in the bog dis- 
tricts of Ireland than for a great, strapping Biddy Mul- 
doon to come into your office with the solemn state- 
ment that she has "a shnake in the inside of her." She 
will even tell you exactly how she happened to swallow 
it: namely, by falling asleep under a tree in the harvest 
field with her mouth open. If you doubt her diagnosis, 
she promptly informs you that she can feel it squirm- 
ing, and that she has to eat twice as much as she did 
before, one portion for herself and the other for the 
snake. 



382 COMMON DISEASES 

A similar delusion is exceedingly common in the Lon- 
don slums, only there, instead of a snake, it is some mys- 
terious jabberwock of a beast known as a " tiger." 

This is not so utterly irrational and incomprehensi- 
ble as one might at first sight imagine; for all of these 
poor people, on account of the coarseness and, often, 
badness of the food which they are obliged to thrust 
down to satisfy the cravings of hunger, suffer fright- 
fully from attacks of burning acid dyspepsia; and 
the burning, griping pains which occur in the course 
of it are not at all unlike such as might be produced 
by the claws or teeth of some carnivorous boo j urn 
which had been swallowed. Of course, the writhings 
of the snake are merely the abnormal contractions 
and twistings of the intestines. 

I have met with only one of these " dragons " on this 
side of the Atlantic, but that is vividly impressed upon 
my memory. I received one afternoon an urgent call 
to go to such and such a number to see a woman who 
was "awful sick." Arrived there, I found a rather in- 
telligent-looking young woman in a state of wild ex- 
citement, verging upon nervous collapse. 

"Oh, doctor, I have got a snake in my stomach! 
Can you get it out without killing me?" 

"How do you know it is there? " was my question. 

"Oh, I just saw the head of it about twenty min- 
utes ago!" 

I assured her that I was death on snakes, gave her 
an emergency dose that I knew would not do any par- 
ticular harm in any case, and she became calm enough 
to tell me her story. 



IMAGINARY DISEASES 383 

The earlier symptoms were clear enough, but I could 
make neither head nor tail of the snake's head episode, 
but thought, just to satisfy her and to get a circumstan- 
tial statement as to exactly where she had seen the 
snake's head, that I would look at her throat. I got her 
in front of the window, focused my mirror upon her 
throat, and behold, the mystery was solved. 

She had a perfectly enormous pair of tonsils, one of 
which was crammed to the bursting-point with those 
accumulations of cheesy matter which form in the little 
spongy cavities or crypts of the gland. These seldom 
attain a size larger than about that of a grain of wheat 
and then drop into the throat, are coughed up, and 
give an exceedingly disagreeable taste and odor if 
they are crushed. In her case, however, some of them 
had grown to the size of small marbles, and one of 
the largest of them had evidently just dropped out 
into the throat, leaving a hollow which had been occu- 
pied by it, into which I could easily have thrust the 
end of a cigar. I asked her the color of the head of the 
snake, and she replied: "A kind of gashly yallerish 
white," which, of course, was precisely the tint of the 
cheesy nodule. 

I knew that it was useless to argue against her delu- 
sion, so simply told her that the medicine that I would 
give her would not only kill the snake, but dissolve it 
so that she would never see or hear anything more of 
it or its remains. It did, and she was perfectly de- 
lighted with her cure and my skill. 

It may be said in passing that the widespread popular 
belief in worms as a cause of disease is a survival of the 



384 COMMON DISEASES 

snake delusion, though it has an apology for a basis in 
fact, in that several forms of Cestodes, Nematodes, and 
Taeniae do occasionally inhabit the human alimentary 
canal. They are, however, comparatively rare, and 
even when present give rise to no disturbance whatever 
of the general health in nine cases out of ten. The tape- 
worm specialist belongs with the magician, the fortune- 
teller and other Nature-fakers, and he is rapidly losing 
his hold as rational medicine spreads and the wise 
woman and the seventh son of a seventh son recede. 
As an illustration of the actual rarity of tapeworms, it 
may be mentioned that nearly all these " worm doctors " 
or manufacturers of vermifuges have a standing offer 
of good round thumping sums for the discovery and 
handing over of a planarian of really dramatic and 
effective proportions, which can be exhibited as 
"taken" by their remedies. 

Then there is that large and interesting group of 
pseudo-sufferers who not merely imagine themselves to 
be ill but produce the symptoms which may be required 
to make others share their belief. 

Many and many a young doctor has been puzzled 
almost to distraction by a skin eruption which steadily 
spread over the body in spite of everything that he 
could do to cure it, to suddenly have the mystery solved 
one day by a nurse or some member of the family dis- 
covering the patient painting croton oil or some other 
irritant over the surface in the direction that he wanted 
it to spread. 

One of my colleagues during his interneship in a 
large Eastern hospital had a most singular case of this 



IMAGINARY DISEASES 385 

description. A young girl was brought in suffering 
from an opening or sinus in her arm about six inches 
below the elbow, from which both matter and pieces 
of bone kept discharging. It was carefully washed out 
with antiseptics, scraped and closed, but next morning 
was found open again, and a day or two later out came 
another piece of bone. The sinus kept burrowing up 
the arm until, finally, it had passed the elbow and 
started up the upper arm. 

Now a bone sinus which travels up and past a joint 
without involving the cavity of that joint is an excess- 
ively rara avis, so a careful watch was set. That the 
pieces of bone came from the sinus there could be no 
doubt, as they were repeatedly washed out in syringing 
and cleansing it. 

But one day the girl was detected by the nurse care- 
fully cutting off the little bits of bone which were found 
by her in her breakfast bacon and slipping them under 
her pillow. The hint was enough. All her bacon and 
every other kind of meat was carefully cleared of every 
possible scrap or trace of bone before it was given to 
her, and the discharge of bone stopped absolutely. 
Then pieces of bacon were given with the little frag- 
ments of bone marked or stained in some peculiar 
way, and these were promptly recovered from the 
sinus. And yet, when that patient was confronted 
with her treachery, she not only refused to confess but 
roundly abused both nurse and doctors, and stormed 
out of the hospital in a fury of rage. 

Another performer of this class who is most familiar 
in the experience of the profession is the woman who 



386 COMMON DISEASES 

has an artificial temperature. A patient will be under 
your care for some nervous or mild chronic disorder. 
About the time that she should be beginning to get 
better, and, consequently, is not receiving quite as 
much anxious attention and sympathy as she did in the 
beginning, a new card must be played to hold the cen- 
tre of the stage, and up goes her temperature to one 
hundred and three and one hundred and four, or even 
one hundred and six degrees. You gasp with dismay. 
Here is a septic complication somewhere which you 
have totally overlooked. A most searching examina- 
tion, however, fails to discover anything whatever 
amiss apart from the astonishing temperature. But 
the patient is handled and waited on as if she were 
Sevres china for two or three days, and her tempera- 
ture goes down again. 

No sooner does interest in the case begin to slacken 
again than the fever thermometer does another moun- 
tain-climbing stunt. Again an examination shows 
nothing amiss, and you begin to be suspicious. 

A little investigation shows either that the patient 
has taken her own temperature and then shown the 
thermometer registering that torrid degree, or else that 
she has sent the nurse out of the room on some pretext 
or another while the thermometer is still in her mouth. 
Further investigation elicits the fact that she has just 
called for a cup of tea, or has had her breakfast brought 
in, or has had the hot-water bottle refilled, within ten 
or fifteen minutes of the temperature-taking. Fever 
thermometers, it should be explained, are usually self- 
registering, and the mercury will remain at any tern- 



IMAGINARY DISEASES 387 

perature to which it has been raised until it is shaken 
down again. 

The ingenuity of the ruses to which these tempera- 
ture raisers will resort is almost incredible. Some of 
them continue to puzzle us even to the last, by having 
developed some curious trick of twirling a thermometer 
rapidly under the tongue, or rubbing it vigorously in 
the blanket, or chafing it between the palms of the 
hands in such a way as to raise the temperature by fric- 
tion; so that several of these cases have actually been 
seriously reported in medical journals as having a 
faculty of raising their temperature to any desired 
pitch at any time they wanted to. 

It would hardly seem possible that there could be 
such a thing as a fashion in disease, which people have 
sufficient control over their symptoms to follow. Yet 
almost any physician of experience will have a score of 
patients in a given period or season who will come into 
his office, firmly convinced that they are all suffering- 
from the same malady. The phenomenon of course is a 
purely psychic one, and yet like all such, it has a physi- 
cal basis, and is one which is full of interest, as throw- 
ing light upon some of the obscurest problems in 
medicine, the relation between mind and body in 
disease. 

The first thing to be frankly premised about these 
followers of pathological fashions, is that the over- 
whelming majority of them really have something the 
matter with them. Popular impression to the contrary 
notwithstanding, it is a distinctly rare occurrence for a 
perfectly or even reasonably healthy man or woman to 



388 COMMON DISEASES 

imagine themselves sick. In one sense, there is no such 
thing as an imaginary disease. 

An imaginary disease is usually a perfectly definite 
result of a real abnormal condition, poisoned nerves, 
starved or over-gorged stomach, under-ventilated 
lungs, overworked muscles, or under-rested brain cells. 

Most of the delusions under which imaginary invalids 
labor, instead of being, as is popularly supposed, "made 
up out of their own heads," are really on the order of 
mild deliriums, hallucinations like the deliriums, the 
nightmares and the grisly dreams of fever. Once let 
something go wrong in the body chemistry, or in the 
mechanism of immunity to the toxins of mild infec- 
tions, and the nerves fed by and bathed in poisoned 
blood promptly begin to build those images of suffer- 
ing and disaster known as " diseases of the imagination. " 

The chief work of the imagination in disease lies in 
the explanations which it furnishes of those vague, but 
genuine, sensations of discomfort, — those headaches, 
eye-aches, backaches; those sensations of dizziness, of 
suffocation, of bursting with gas; the sensations of 
sinking, of causeless fatigue and apathy; and second, 
in the picture which it constructs out of these materials. 
Here its prowess is simply boundless, and its power of 
leaping to conclusions equal to that of the deathless 
cow that jumped over the moon. 

These "neurotics" always have a proper pride about 
them. They are seldom satisfied with anything short 
of the very deadliest and most dramatic of diseases, 
and if they can only hear of a particularly rare and 
interesting malady, that is the one which they promptly 



IMAGINARY DISEASES 389 

decide they have. Usually the physical basis is patheti- 
cally and almost ludicrously apparent. Those who suf- 
fer from acid dyspepsia, with its often really distressing 
cutting and burning sensations in the stomach, are 
quite sure that they have cancer, and though they ex- 
press themselves as relieved, are often in their heart 
of hearts, disappointed, when you assure them that 
there is no basis for their fears. 

Those who have palpitation, from the upward pres- 
sure of a gas-distended stomach, pushing the diaphragm 
against the heart, are quite sure that they have a seri- 
ous form of organic heart disease, and are marked for a 
dramatic and sudden death. Those who have the little 
sensations of numbness, and tingling in the legs and 
arms, which are frequently associated with a poor 
circulation, or with blood overloaded with waste pro- 
ducts, are equally certain that these are the early signs 
of paralysis, and that they will soon be palsied and 
helpless; and so on all along the line. 

Here is where the quack and the patent medicine 
man reap their harvest. These poor people know that 
they are suffering, but without knowing why, and are 
eagerly groping about for an explanation. Along 
comes the skillful advertiser, with his familiar ques- 
tions : — 

"Do you feel disinclined to get up in the morning?'* 

"Have you a weak back?" 

"Do you wake with a dark brown taste in your 
mouth?" 

"Are you subject to headaches?" 

"Have you a sense of fullness after meals?" 



390 COMMON DISEASES 

And so on, — a fiendishly ingenious melange of the 
general commoner symptoms of the neurotic, combined 
with sensations which a perfectly healthy individual 
can discover in himself at any time if he begins to think 
about them, or, as Mrs. Leeks expressed it, "to live 
in his own insides." 

The neurotic reads the list of symptoms with open 
mouth and growing conviction, and the final trium- 
phant conclusion, "Then you have kidney disease, 
and Pond- Weed Bitters will cure you," is accepted as 
gospel. 

The other touch which "gives to these airy nothings 
a local habitation and a name," is the hearing or the 
reading of dramatic or striking cases of some particular 
disease. This last influence is what usually gives us 
our runs of fashions in disease. Often the connection is 
absurdly easy to trace. Given an operation or death 
from, say appendicitis, or cancer, in some prominent 
person in the community, and you are nearly safe to 
see within the next ten days from two to a dozen pa- 
tients — according to the size of your practice, who are 
convinced that they are suffering from one or the other 
of these diseases. Older physicians have told me of the 
scores of cases of women who used to come into their 
consulting rooms during the last illness of General 
Grant, firmly convinced that they were developing 
cancer of the tongue or throat, a form of the disease 
which is almost unknown in women. 

Twenty to thirty years ago, when the ponds and 
sloughs and swamps had not been drained, and mos- 
quitoes and malaria were abundant, all these vague 



IMAGINARY DISEASES 391 

symptoms were put down to "mylary," and patients 
dosed themselves until their heads rang with quinine, 
before they even consulted a physician. 

Similarly in epidemics of influenza, every group of 
sensations of discomfort and ill-health of which the 
patient does not know the cause, is promptly put down 
as "the grippe," and your waiting-rooms are filled with 
patients who come to you with a ready-made diagno- 
sis, and simply want a prescription for what you 

give for the grip . ' ' Half of them perhaps really have it. 
The remainder are simply following the fashion. 

Some of the most ludicrous of these manufactured 
diagnoses are those that are made by the family of the 
patient. I recall one particularly bizarre illustration 
in the case of an old colored man who had had a stroke 
of paralysis. This had happened to occur during a 
severe thunderstorm, and nothing would persuade the 
family first of all, that he had not been struck by light- 
ning, although there was not a particle of evidence that 
an electric current had passed anywhere near him, — 
merely that he was found unconscious after the storm 
was over. But my skepticism as to their explanation of 
his condition appeared to have unsettled their minds as 
to both diagnoses, and they were greatly exercised about 
the matter. Finally, however, about the fourth day, 
his son came into my office with a triumphant grin all 
over his countenance and greeted me : — 

"Doctah, we's foun* out what's de mattah wid de 
ole man now. He's done got his speech back now, an' 
he talks of nuttin' but ribbers an' lakes an' cataracks. 
So we all reckon he's got wattah on de brain J" 



392 COMMON DISEASES 

This sort of misinterpretation will of course account 
completely for those cases of imagined cancer, appen- 
dicitis, paralysis, etc., in which there has already been 
pain or a twitching in the region supposed to be 
diseased, but the power of imagination goes even far- 
ther than this. It will actually produce sensations, not 
merely of discomfort, but of acute pain in regions in 
which the ulcer, cancer, or other mortal malady is sup- 
posed to exist. 

And this throws a light upon one of the most puz- 
zling and singular powers of the human mind over the 
body. It is of course in large part illusion, and yet 
there is a definite physical basis for it, not merely in 
pathology and psychology, but actually in anatomy. 
Pain is, of course, a purely subjective symptom, and is 
felt in the gray matter of the cortex of the brain. By 
the curious method of construction of our nervous 
system, unpleasant impressions which are made upon 
the area in this cortex which controls a certain region 
of the body, are interpreted by the mind as pain in that 
particular region or organ. So that, given an abnormal 
condition of the general nervous system, a very slight 
attack of real pain in a particular region or organ will 
throw its centre in the cortex into such a state of dis- 
turbance as to keep up after-waves, or so to speak, 
echoes of pain, for an almost indefinite period after- 
ward, particularly if attention is kept continually and 
expectantly concentrated on this particular region and 
pain. 

Nearly all these sufferers have a certain amount of 
neuralgic or other pain in the region or organ com- 



IMAGINARY DISEASES 393 

plained of, to begin with as a basis, and after a little 
time they become positively incapable of distinguish- 
ing between the pain which they actually are now, or 
may not be, suffering, and the memory of the pain 
which they were suffering twenty or thirty minutes or 
even two or three hours before. Not only so, but as has 
already been intimated, if a sufficiently vivid mental 
impression, such as would be produced by reading of or 
seeing the agonies of a case, say of appendicitis, be 
made upon this centre in the brain it is not difficult in 
susceptible individuals, to make them begin to refer 
this disturbance to the region of the body which this 
centre controls. For instance, I have actually known 
young surgeons who confessed to me that after seeing 
their first death from appendicitis, they were conscious 
of a burning pain down in the "appendix" region, in 
their own right groin for several days afterwards, and 
were half in fear that they were actually coming down 
themselves with an attack of appendicitis. 

Another physical fact which makes it easy to deceive 
ourselves, even quite unconsciously, is that nearly all 
our pain is what the physiologists call "ref erred." 
That is to say, we feel it in a certain area of the brain, 
and because the nerves running to that area of the 
brain come from a particular part of the body, we refer 
the pain to that part of the body. If we were to pick up 
the sensory nerve, say from the thumb, and that from 
the little finger, cut them across and graft the severed 
end of one into the cut end of the other so as to cross 
the sensations, any pain then experienced in the thumb 
would be promptly referred to, or as we would say, 



394 COMMON DISEASES 

felt in, the little finger or vice versa. Nay, this 
"crossed" condition occurs even in the normal body. 

The great internal organs, like the heart, the liver, 
the intestines, etc., have no direct connection with the 
brain, but switch in as it were on the cable lines con- 
necting the surface of the body through the spinal cord 
with the brain. In an attack of acute and intensely 
localized inflammation like appendicitis, for instance, 
the pain or sensations giving rise to the pain are trans- 
mitted through the sympathetic nervous system to 
the spinal cord, where it switches in on to the line of 
the ordinary sensory nerve running from the skin of 
the surface of the abdomen covering the part. Conse- 
quently, the pain is referred to the area of distribution 
in the skin of this particular nerve. Oddly enough, in 
the case of appendicitis, it is often referred two to four 
inches above the actual seat of the inflammation. 

A careful mapping out of the surface of the abdomen 
shows that inflammation in a certain organ will pro- 
duce pain and tenderness on pressure on the surface of 
the body over that organ but from one to three inches 
above or below its precise location. So that, to put it 
roughly, when our nervous system gets sufficiently 
poisoned or otherwise put out of gear, it is practically 
impossible to say what pain we suffer or where it comes 
from with' any degree of accuracy, and the possibilities 
of self-deception are simply limitless. 

Upon this strange "reference" fact are based the 
curious impressions which individuals, who have lost 
a limb, will get as to what is going on in the fingers or 
toes of the limb which has been cut off. Ask any one who 



IMAGINARY DISEASES 395 

has had a limb amputated, and they will tell you that 
for weeks and months afterwards, they were conscious 
of itching or tickling sensations in the toes or fingers of 
the limb that had been cut off and had to look down to 
the stump to actually assure themselves that it was 
gone. This seems almost incredible, but can be verified 
by asking the question of any one-armed or one-legged 
man that you happen to know. 

The explanation is simple. In the stump of the arm 
or limb lies, of course, the nerve trunk. This was cut 
squarely across in the process of amputation, and in so 
doing, the whole bundle of fibres, each of which led 
from some particular area of the limb below, was left 
exposed, as would be the cut ends in the wires in a 
main line telephone cable. Whenever in the course of 
healing or in the process of suppuration in the stump, 
one of these cut fibres happened to be irritated or stimu- 
lated, it sent an impression to the brain, and that was 
promptly translated as having come from the thumb, 
little finger, or palm which that nerve trunk formerly 
supplied. 

Men may often have a limb amputated under chlor- 
oform and not know for days afterwards that this has 
been done. A poor fellow one day came into the hos- 
pital in which I was an interne, with a large tumor on 
the lower third of the thigh bone. It was carefully 
examined, a consultation of the staff held, and the pa- 
tient told that it was probably a form of bone cancer, 
(sarcoma), and that the only thing to do was to cut 
down upon the tumor, and if it were found to be can- 
cerous, to remove the limb in order to save his life. If 



396 COMMON DISEASES 

i 

it were not cancerous, it would be sufficient simply to 

remove the tumor. 

He consented to this advice and was put under ether 
with the understanding, that if it were possible to 
remove the tumor without taking the limb, this 
would be done. If not, the limb would be amputated. 
The tumor was found a sarcoma of the most malignant 
type, and the limb was amputated about the middle of 
the thigh. The patient was in feeble condition before 
the operation, lost a great deal of blood, and the cut- 
ting through of a great bone like the femur is always 
a serious shock; so that his condition was considered 
decidedly critical. To our astonishment, the first 
thing that he said on coming out from under the ether 
was, "I am so glad you did n't have to take that leg 
off." The nurse gasped, but wisely held her tongue, 
and it was decided not to undeceive him until he had 
begun to regain his strength and was considered out of 
danger. 

For five days that patient lay there in bed uncon- 
scious that his limb was gone. The cut end, of course, 
of the great sciatic nerve was continually sending mes- 
sages to his brain, which he had interpreted as coming 
from knees, ankles, and toes. At the end of that time, 
he had rallied sufficiently, we judged, to bear the shock, 
and he was told. And we had to lift the bedclothes 
and show him the stump before we could make him be- 
lieve it. He was, however, strong enough to stand the 
shock of the disappointment and made a rapid and 
uninterrupted recovery. 

Another case illustrating this same singular ana- 



IMAGINARY DISEASES 397 

tomical fact was that of a poor old Irishman whose hand 
I was obliged to amputate just about the middle of the 
fore arm, on account of an intractable disease of the 
bones of the hand and wrist, which was causing blood 
poisoning and threatening his life. The amputation 
was, of course, done only as a last resort after the 
disease had resisted every imaginable form of local 
treatment. And the old fellow very pluckily asked us 
after the hand was taken off, to keep it long enough to 
make a thorough examination so as to find out exactly 
what had been the matter. Then after this, of course, 
he wanted to have it buried where it could be got at 
and laid with him in his coffin. For, as is very common 
with the more ignorant class of European immigrants, 
they don't like to be buried with any of their limbs or 
organs gone for fear that these will fail to turn up in 
the resurrection. And I, accordingly, took the hand 
aid portion of arm down to my office after the opera- 
tion. 

Next morning, when I went into his room, the old 
man was very much better. His fever had gone down, 
he had almost no pain, and he was greatly delighted to 
be rid of his diseased hand. There was only one mote 
in his sunbeam, and that was that "that there hand 
of mine hez been dropped into that jar of alcohol all 
kind of doubled back on itself. I've been feelin' it 
crampin' that way all night. Doc, you jest did n't 
notice it when you put it in, but when you go back to 
the office, I jest wish you 'd take it out and straighten 
it." 

This I readily promised, first taking care to elicit 



398 COMMON DISEASES 

from him the precise position in which he believed the 
hand and wrist to be cramped, which was, perhaps 
naturally enough, with the fingers doubled backward 
and the wrist bent in the same direction. 

As soon as I got down to the office, I went to the jar 
containing the specimen, and there discovered, much 
to my amusement, that the hand was in exactly the 
opposite position, namely, closed and flexed upon it- 
self, with the wrist bent in that direction. I left it 
exactly as it was and went on about my work. 

That evening I could not resist the temptation of 
dropping in to find out the result. The old man greeted 
me with a radiant smile. "It's all right now, Doc." 
"About five minutes after you got down to the office — 
I timed you, I knew you were going right down — that 
kink straightened right out and I have n't had a bit of 
trouble with it since." 

It would have been cruel to undeceive him. And 
I have no doubt he is still relating this remarkable 
incident of telepathy between himself and his severed 
hand to admiring grandchildren. With such traitors 
as this within the camp, with our nerve- wires carrying 
misleading messages, is it any wonder that our Oriental 
imaginations can construct out of almost any group of 
uncomfortable sensations, a simulacrum of any disease 
which we read or hear about with sufficient vividness 
and impressiveness. 

The malade imaginaire who is able, in the graphic 
language of the street, "to throw a fit," or go into a 
faint or develop an agonizing sick headache whenever 
she needs a little additional sympathy or dramatic 



IMAGINARY DISEASES 399 

assistance in getting her own way, is, of course, a type 
as painfully familiar to the laity as it is to the pro- 
fession. 

The psychology of these self-made invalids is ex- 
ceedingly curious and interesting, and yet simpler and 
more explicable than would appear at first sight. It is 
really unjust to them to say that it is entirely or even 
in large degree intentional. In fact, in the beginning, 
their sufferings are just as real to them as if they were 
in deadly peril of their lives, and even throughout the 
entire course of their disease, they often succeed in 
deluding themselves as completely as they do their 
families and friends. 

The basal motive underlying the whole singular 
drama is a longing for sympathy, the desire to attract 
attention and to hold the interest of some individual 
or group of individuals. This impulse, of course, is 
common to us all and is a perfectly natural and whole- 
some one, provided that proper means are taken to 
gratify it. 

Those of us that are fortunate enough to have tal- 
ents of some sort or description, conversational, musi- 
cal, financial, artistic, are able to make ourselves inter- 
esting to our friends and acquaintances by these 
means; and we are just as touchy and as fussy over any 
little slight, real or imaginary, upon such little reputa- 
tion as we may pride ourselves upon in any of these 
regards, as the malade imaginaire is about lack of 
adequate sympathy with her sufferings. But there are, 
unfortunately, a large majority of us who are almost 
utterly destitute of any of these little graces and ac- 



400 COMMON DISEASES 

complishments and who find it difficult to retain much 
more than a mere polite tolerance of our existence on 
the part of our acquaintances and perhaps even of our 
family. 

There is just one card, however, which we can all of 
us play at any time and invariably with trump effect, 
and that is, to fall sick. We are given a place in the 
limelight at once and overwhelmed with sympathy and 
offers of assistance and anxious inquiries after our 
condition. Is it any wonder that persons who are 
either destitute of any special gifts or too lazy to exert 
those they have, should attempt to repeat this delight- 
ful rush of sympathy and interest as often as their 
consciences will admit, and where they happen to be 
lacking in proper control, to gradually form a more 
or less constant habit of it. 

The singular claim which sickness and suffering 
makes upon our sympathies is, of course, one of the 
main reasons why in certain circles the two topics 
which are invariably sure to elicit an animated 
and interesting discussion are symptoms and hired 
girls. 

There can be no question that the scheme works 
gorgeously, especially upon the crude and unsuspecting 
male. I have seldom known a hysterical married 
woman whose husband did not think that the sun 
fairly rose and set in her. And it is a matter of common 
experience with physicians that the greatest difficulty 
in bracing these patients up and getting them to behave 
like rational beings lies not so much with them as in 
their immediate family, who believe in the reality of 



IMAGINARY DISEASES 401 

their symptoms even more devoutly than they do 
themselves. 

The popular impression that these manifestations 
are confined to the gentler sex is far from correct. Any 
physician of experience can recall scores of hypochon- 
driacs, imaginaires, and even of straight-out cases of 
hysteria among men. And these are among the most 
troublesome and intractable cases of this class that we 
have to deal with. Indeed, if we include, in this class, 
as in the majority of instances it is really just to do, 
the man who is fussy about the precise texture of his 
bread and the exact temperature of his coffee and the 
dryness or dampness of his sheets, who is afraid of a 
draft, or thinks he will catch his death of cold if he gets 
his feet wet, and that the heavens will fall if his dinner 
is five minutes late, or if he has to sit up half an hour 
beyond his usual bedtime, the numbers in the two sexes 
will pretty nearly strike a balance. 

Women, in spite of their sensitiveness and fastidious- 
ness about some matters, have a singularly robust 
indifference to a number of trivial little details of 
imaginary hygienic importance which weigh heavily 
upon a certain type of precise and particular masculine 
minds. And, of course, when men once really are sick, 
they are notoriously the most unreasonable and frac- 
tious and unmanageable patients that we have any- 
thing to do with. Either there is nothing whatever the 
matter with them, and the doctor and their families 
are silly alarmists who are in league to keep them in 
bed when nothing is the matter, or else they are a 
great deal worse than the doctor will admit they are 



402 COMMON DISEASES 

and are sure that those around them are concealing the 
truth from them for fear it would frighten and dis- 
courage them to know the worst. Some of the fussiest 
and most whimsical patients I have ever had to do 
with have been men, and almost any physician of 
experience will corroborate my statement. 

One in particular I remember, a cultured, wealthy 
old Easterner, who, on a trip through the West, was 
seized with a mild attack of pneumonia. Although the 
disease ran the mildest possible course and rapidly 
terminated in complete recovery, he insisted upon 
regarding himself throughout the entire ten days as 
having one foot in the grave and the toenails of the 
other digging hard into the turf. 

His particular dread was lest he should become 
chilled, especially as the very comfortable room in 
which he happened to be, was heated by a stove in- 
stead of a steam radiator. One morning when I came 
to his bedside, I was astonished to have him put out 
his hand encased in a wool-lined and fur-trimmed 
glove, with the remark, "You must excuse my glove, 
Doctor, but I am so afraid of these dreadful drafts.' * 
The next day I was hardly surprised when the nurse 
informed me that he had asked for a glass of water, 
and when she handed it to him, asked her for his glove, 
which he carefully drew on before he would touch the 
chilled surface of the glass ! ! If any woman could bet- 
ter that for whimsicality, I should like to hear from 
her. 

Unquestionably, the larger part of these invalids 
are women, but this is very readily explained. First 



IMAGINARY DISEASES 403 

and chiefly, in my judgment, because while illness or 
suffering in a woman instantly and irrepressibly ex- 
cites sympathy and pity, it is not so sure to produce 
this effect in a man. 

It has ever been the tradition of the ages to regard 
woman as the weaker sex and to protect and pity her 
and put up with her whims as being a part of the natu- 
ral and necessary scheme of existence. In fact, most 
men rather enjoy having to do a reasonable amount of 
petting and consoling and humoring. But the instinct- 
ive feeling about a man who is sick is almost precisely 
the reverse. In the first place, unless he happens to be 
a near relative, you are rather annoyed, because it 
interferes with his efficiency and prevents him from 
doing something which you had relied on his doing. 
In the second place, unless he is obviously and visibly 
so ill as to be in danger of his life, both the patient and 
his associates are inclined to regard illness as some- 
thing to be ashamed of. And even in the protoplasm of 
the gentler sex there is a singular kink in this same 
direction. 

The women of his family are kindness and sympathy 
itself to a man when he is sick, but they don't expect 
him to be sick too often. It is n't manly and it is n't 
according to the reasonable probabilities of the situa- 
tion or the rules of the game. And while genuine and 
serious illness will often bring out the noblest and most 
unselfish qualities of devotion in a wife or a daughter, 
chronic illness, especially of a kind that produces no 
very striking visible symptoms, and is apt to occur 
when there is something toward that the patient does 



404 COMMON DISEASES 

not want to do, is almost certain to excite suspicion, 
if not disgust, in the feminine mind. 

While the majority of hysterical and nervous wo- 
men are firmly believed in by their immediate families, 
the majority of self-made invalids and hypochron- 
driacs among men are at least strongly suspected to be 
humbugs by the women of their household. So that 
while one sex has every encouragement to persist in 
its little series of spectacular effects, the other is 
sternly discouraged. 

The other great reason is, that men for the most part 
are driven by the clock and the time card ; they must 
either be fit for duty or in bed ; there is practically 
no intermediate ground that is permissible, while the 
woman has a whole continent of hazy, half-way, shoal- 
water anchorages between perfect health and com- 
plete disability in which she may drift for months and 
even years at a stretch without ever having to de- 
finitely declare her precise latitude and longitude. 



CHAPTER XIX 

THE PREVENTION OF OLD AGE 

EVERY process in nature is tolerable and even 
enjoyable when it comes — except, perhaps, birth. 
From the vigor with which we wrinkle up our features 
and squall when the light of day first strikes us in 
the eyes, it is generally assumed that for reasons best 
known to ourselves, we thoroughly disapprove both of 
our new surroundings and of the process which brought 
us hither. But this is merely assumption, and our per- 
sonal recollections upon the point are of the vaguest 
and would hardly be accepted as evidence, even by an 
ex-corporation lawyer trying a Standard Oil case. Be 
this as it may, however, no outcries, however lusty, on 
our part could do adequate justice to the sufferings of 
the other player in the great drama of the New Life. 
Childbirth and the field of battle, these are the two 
supreme blood sacrifices of woman and of man. But 
we have unanimously agreed to ignore this one really 
disagreeable natural incident in our lives and to con- 
centre all our anticipations of dread and terror upon 
the opposite end of our career when we make our exit 
from the stage of life. 

We dread death, which ninety-nine per cent of us 
meet with far less outcry than we do birth, and we look 
forward with great misgiving and forebodings to that 
last act of life's drama which precedes the final falling: 



406 COMMON DISEASES 

of the curtain, old age. Why the process of getting old, 
of relaxing our exhausted hold upon life, should be 
either difficult or painful is hard to conceive upon a 
priori grounds, and as a matter of fact we have abund- 
ant evidence from the mouths of those persons whose 
testimony alone is of any weight, the dying themselves, 
that in the phrase of the Grand Monarque, "Dying is 
very easy." Death is as natural and painless as the 
fading of a flower or the falling of a leaf, and as wel- 
come as sleep to the weary. Is it not possible that we 
have allowed the shadow of this imaginary, this self- 
created and superstition-conjured dread of our final, 
peaceful exit to overcast, as unnecessarily as illogi- 
cally , that stage of our life which is the most peaceful, 
the sunniest, and the richest in happy numbers, old 
age ? We shall all grow old one day if we have the luck 
to live long enough, and any attempt to avoid this in- 
evitable event is as rational and as manly as the flight 
of Frederick the Great's cuirassiers at the battle of Leu- 
then. The eagle eye of the great general marked their 
flight, and he dashed after them as hard as he could 
gallop, bawling in disgusted tones at the top of his 

voice, " Come back you scoundrels ! What the are 

you running away for? Do you want to live forever? " 
But a healthy, honorable, natural old age is one of 
the happiest things that can happen to us, the crown 
and reward of a well-spent life, no more to be dreaded 
or feared than a natural death. The only pains and 
penalties of old age that we dread are those brought 
upon us by our own individual misfortunes or our fol- 
lies, both of which are now largely preventable, which 



r 



THE PREVENTION OF OLD AGE 407 

the most completely so, it would be really hard to say. 
It is often not our follies for which we are most severely 
punished but certain of our so-called minor virtues. 
Overwork causes far more unhappiness and suffering 
in old age than overplay does. Old age is what we 
make it, both as individuals and as a community. 

Where there is no way of preventing old age itself, 
save by the rather heroic remedy of dying earlier, 
which is scarcely worth while for this purpose alone, 
it is perfectly possible to prevent most of the limita- 
tions and cripplings, which alone make old age to be 
dreaded, by the exercise of our intelligence and our de- 
termination. Many, if not most, of the changes which 
we associate with age, which we have in mind when we 
think of growing old, which in our pompous, technical 
terminology we allude to as senile degenerations, are 
the result of infectious diseases and of bad hygienic 
habits. For instance, remote at first sight as the con- 
nection may seem, binding together with one link our 
first and our second childhood, very many of the 
disabilities of old age are the results of those lightly 
regarded and almost despised infections, Children's 
Diseases and Common Colds. It seems ludicrous to 
think of a grandfather who has not fully recovered 
from measles, or a great-grandmother who is still suffer- 
ing from the effects of whooping-cough, but such long 
delayed Nemeses as these are of painfully frequent 
occurrence. 

It was discovered some years ago by the Royal Com- 
mission on Physical Deterioration, appointed by the 
British government to inquire into the vitality of the 



408 COMMON DISEASES 

nation, that invariably those annual "crops'* of child- 
ren among whom had raged during their second, 
third, fourth, or fifth years an unusually severe and 
widespread epidemic of measles, whooping-cough, scar- 
latina, and diphtheria were found years afterward to 
be half an inch to an inch shorter, five to ten pounds 
lighter, and three quarters of an inch to an inch less in 
chest girth than children of preceding or succeeding 
years who had escaped such an epidemic. And this 
backset in the majority of instances was never recov- 
ered from, but the children remained permanently 
stunted for life. 

A healthy first childhood is the best possible insur- 
ance for a happy second one. In fact, you may have a 
full group of senile symptoms and die of old age at 
forty-five if you are only sufficiently unfortunate in 
your environment in early childhood and in youth. A 
large percentage of the mass of humanity, both men and 
women, do so die old before their time. If you want 
your child to reach a healthy, happy, uncrippled old 
age, guard his cradle and his nursery with jealous care 
against the demons of the Little Fevers of infancy 
and early childhood. Even the so-called deadening 
of the old man's senses, the failure of his hearing, the 
dimming of his eyesight, are due, nine times out of ten, 
the one to successive attacks of uncured or untreated 
colds, which spread from his throat up to his Eusta- 
chian tube, to his drum and the bones of his middle ear, 
and the other to that decay of the vitality of the cen- 
tre of his crystalline lens, under the infections, shocks, 
overwork, and underfeeding strains of life, which 



THE PREVENTION OF OLD AGE 409 

we call cataract. There is no longer any need in a 
hygienically intelligent and healthful community that 
either "all the daughters of music shall be brought 
low" or that "those that look out of the windows 
be darkened." 

Three quarters of the cripplings of the old man or 
woman which chain them to their chairs, or make 
their old bones a torture to them half the night long, 
are not due to any normal or necessary process con- 
nected with growing old or advancing years, but to 
some form of rheumatism, which is almost invariably 
an infection, or the result of some form of infectious 
disease. If you have the good fortune, or the good 
management, to avoid tonsillitis, influenza, pneu- 
monia, typhoid fever, pus infections, and particularly 
gonorrhea and syphilis, you will have avoided three- 
quarters of your risks of stiffened limbs and swollen 
joints in your declining years, to say nothing of par- 
alysis, heart disease, Bright's disease, cirrhosis of the 
liver and arterio-sclerosis in adult life and middle age. 
Of course, as yet, it is not within human power to 
avoid all, or even a majority, of these maladies and 
misfortunes, but it is becoming more and more nearly 
so every day, and the fewer you have of them, the bet- 
ter your chances for escaping these later cripplings and 
degenerations. Every infectious disease that you can 
cross off your vital slate means five more chances in 
the scale of one hundred for a happy and comfortable 
old age, and this is especially true of those calamities 
whose avoidance is already in the power of every one, 
the so-called venereal diseases. The old man may 



410 COMMON DISEASES 

chuckle in retrospect over the sowing of his wild oats, 
but his chuckle is apt to change into a groan when its 
vibrations reach his gonorrhea-crippled elbow, or his 
smile be twisted in a wry grimace by the failure of the 
syphilis-paralyzed corner of his mouth to take part in 
it. The old man's conscience may not worry him much, 
but nature has other methods of evening up the score. 

On the other hand, all the so-called senile changes 
may be produced at a pitifully premature period and 
in actual life are so produced with painful frequency, 
by either underfeeding or overwork at an early age, 
or by confinement in foul air and without proper ex- 
ercise. The most potent general cause of old age, in 
fact, is that delightful combination of all three of these 
degrading influences, which has been exalted by re- 
ligion as a means of grace under the title of poverty. If 
you want to live to a good and comfortable old age, 
don't be poor. The popular delusion that it is among 
the poor and lowly that great age is most apt to be 
attained is simply due to the fact that the poor grow 
old so soon. The average " centenarian" huddled in 
the almshouse or sitting in the sun beside his cottage 
door, though he looks every inch of his one hundred 
or even hundred and ten years in decrepitude and 
bodily decay, is usually found on investigation to be un- 
der eighty, or else to have no evidence or proof what- 
ever when he was born. He is a hundred, poor old chap, 
not in years, but in toil and privations and miseries. 

Do not let your children be underfed or overworked, 
whether in the factory or the schoolroom; do not let 
any one underpay or overwork you and you will have 



THE PREVENTION OF OLD AGE 411 

doubled both their and your chances for a good, cheer- 
ful, and enjoyable old age. The poorer and worse fed 
a nation or a class, the shorter its average life, the fewer 
those who ever attain to what might be courteously 
termed a good old age. The Hindu population of In- 
dia, for instance, has an average longevity of twenty- 
three years as compared with our own life average of 
forty-six. Yet they become so old and decrepit at 
forty and furnish such fit material for the fable-monger 
and " centurion "-maker that we actually believe that 
the attainment of a century of life is far commoner 
among them than in Western lands. 

More of us are living to a good old age to-day than 
ever in any age of the world before, and more prob- 
ably in America than in any other country in the 
world on account of the greater and more equally 
diffused prosperity and comfort of all classes and in- 
dividuals. The prevention of old age, in the sense 
of its postponement and of robbing it of most of 
its discomforts, is advancing steadily. Our popular 
belief that the attainment of a good old age was far 
more common in the good old days was simply one of 
our familiar delusions by the rosy light which shines 
upon the past. We imagine that very old people 
were more common, say one hundred years ago, for 
the childishly ridiculous reason that all the men or 
women who were born in that period, whom we person- 
ally have seen or known, were naturally and in the 
nature of the case, very old. In fact, the good old 
ages of the good old days as compared with these de- 
generate ones are about as mythical as our centenarians. 



412 COMMON DISEASES 

How almost purely mythical these latter are may 
be illustrated by one typical instance. There is, or 
was a few years ago, a pensioner carried on the pen- 
sion rolls of the United States Government whose age 
is there set down at the venerable and impressive one 
of one hundred and nine years. This fact was thrown 
in my teeth by a devout believer in centenarians, and 
I accordingly had the old gentleman's record invest- 
igated. I found that upon the books of the Pension 
Bureau were seven different statements of the pen- 
sioner's age made at different periods when he was 
applying for increase of pension, no one of which 
agreed with any of the other six, and was therefore 
not surprised to find at the bottom of the record 
that he had been mustered out of the army at the age 
of forty-three, just forty-three years before, making 
him, according to his then sworn statement, eighty- 
six years old instead of one hundred and nine! But 
this is a trifling discrepancy in centenarians. They 
do not intend to deceive, they simply do not know 
or have forgotten, and their imagination plays them 
tricks. 

It is easy to imagine that we shall be unhappy when 
we are old, and that the old man must chafe against 
his physical limitations, as we would now were they 
to descend upon us in the full flush and fire of youth 
and vigor, just as we imagine that we shall be unwill- 
ing to die when the time comes. To put it to the test 
of experience, think over in your minds the ten, twenty, 
or thirty people that you know who are well advanced 
in years, and decide as best you may whether they are 



THE PREVENTION OF OLD AGE 413 

happy, or unhappy. If you find more than one fifth 
of them in the latter class, it will be unusual. 

Another important point upon which our impres- 
sions deceive us is that old age, being the period at 
which life is necessarily approaching its close, is there- 
fore, inevitably, an age of discomforts, of aches and 
pains, of invalidism and of illness; but the data are very 
far from supporting this. Take any table of mortality 
rates at the different ages of life, compare the earliest 
and latest figures, and the first thing that will strike 
you will be the almost incredible, but paradoxical, fact, 
that instead of old age being the cause of the highest 
mortality, this menace belongs to infancy. The death 
rate per thousand living during the first year of life, 
will range anywhere from one hundred and twenty to 
two hundred and fifty, the average being about one 
hundred and fifty; while that of the decade from 
seventy to eighty, is barely half that; and the period 
from eighty to ninety just about equals it. In other 
words, we die faster, and have more diseases when we 
are babies in the cradle, than we do in our second 
childhood. In fact, the mortality of the aged is 
scarcely greater than that of the child of ten, or the 
man of thirty. 

One advantage of the second childhood is that 
measles, whooping cough, chicken pox and the like, 
have no more terrors for it. The old man is not nearly 
so liable to die of tuberculosis, or typhoid, of syphilis, 
of dysentery, or indeed of any of the acute, infectious 
diseases, except pneumonia and influenza. 

Nor are these the only ills of the flesh that his age 



414 COMMON DISEASES 

has gained him a considerable degree of immunity 
from. One of the rewards that comes to the veteran 
nervous system, after the shock and strain of the 
battle of life, is a curious but distinct balance and 
poise, which it often did not possess in earlier years. 
While its actual vigor of attack and powers of endur- 
ance are somewhat lessened, it is less liable to be thrown 
into the pain panic, or be disturbed in its balance. 
While we take it for granted, with our usual cheerful 
and consoling logic, that anything which we may have 
in the way of a bodily weakness, or tendency to in- 
firmity, must necessarily increase with age, it very 
frequently happens that exactly the reverse is true; 
and the man who suffered tortures from nervous dys- 
pepsia, or blinding agony from sick headaches, or the 
throes of suffocation from hay fever, or asthma, in his 
younger and middle life, may gradually outlive these 
tendencies, and become entirely free from their attacks 
in his declining years. 

Part of this immunity from acute attacks and severe 
pain is probably due to the slight dulling and numbing 
of the keenness of the nerve centres, so that they do not 
react so violently to insults and irritations. But much 
of it appears to be of the nature of a genuine toughen- 
ing against attack, and the later years of life, if less 
passionate than the earlier, are distinctly more peaceful. 
This is reflected in their faces, for peacefulness is the 
dominant note of the expression of the aged. 

In fact, by one of those compensations which nature 
almost invariably provides, the decline of our powers in 
advancing years is accompanied, and usually well pre- 



THE PREVENTION OF OLD AGE 415 

ceded by, a decline of, or alteration in, the direction 
of our inclinations. The man of seventy -five, for in- 
stance, eats less than does the man of forty; and be- 
comes usually somewhat restricted in the number of 
foods that he likes, and inclined to avoid the more 
pungent flavors. But this is simply because his appe- 
tite has gently, but imperceptibly, declined as his fuel 
needs become less; and within the limits of his appetite 
and his simpler tastes, he enjoys his food almost as 
keenly, and digests it, on the average, with rather less 
discomfort than in the maturity of his powers. 

The same thing is true in regard to his powers of 
sleep. He sleeps fewer hours at a time, and probably 
less during the twenty -four hours than in his younger 
days — much less, certainly, than the eighteen hours 
out of twenty -four of babyhood. But this is because he 
is no longer growing, and does n't need to spend so great 
an amount of time in this state of blissful sprouting un- 
consciousness. The sleep that he does take is not so deep, 
but it rests him ; and it is distinctly rare that the old man, 
or old woman, suffers much discomfort from insomnia. 

In fact, a large part of what we are pleased to term 
the "decline of our powers in old age," is really, broadly 
considered, a simple adjustment on the part of nature 
to the conditions of a new situation. The average 
healthy old man no more repines, or considers himself 
ill-used, because he cannot work ten hours a day, or 
throw two hundred pounds over his shoulder, than 
does the rotund, prosperous business man, that he can 
no longer "skin the cat," or turn somersaults, ad libi- 
tum, directly after dinner. 



416 COMMON DISEASES 

He has borne his share of the burden and heat of the 
day, has won his honorable discharge and his pension, 
and can enjoy his well-earned leisure, fighting his bat- 
tles o'er again, musing over what it was all about, and 
watching others toil and sweat as he used to. He is in 
the position of the retired Major in Scott's story, who, 
in his snug little villa, had his servant wake him every 
morning at 7.30 with the call, "Time to dress for pa- 
rade, sir!" just for the pleasure of saying, "D — n the 
parade!" and turning over and going to sleep again. 

As the shrewd old classic proverb has it, " Tempora 
mutantur et nos mutamur in illis " (Times change and 
we change with them) . Nothing but the over- weening 
conceit of youth, or the hot pride of middle life, could 
blind us to the fact that the man of later years enjoys 
himself, within the limits of his new conditions, almost 
as much as we do in the heyday of our powers; only his 
enjoyment is of a different kind. 

That he is adjusted to his new conditions, and has 
not simply, so to speak, crawled into a shell of insensi- 
bility, or indifference, is shown by the fact, which the 
progress of modern surgery has strikingly brought out, 
that his tissues have still an astonishing amount of 
power of repair. Barring certain violent shocks, and 
operations involving long and protracted convales- 
cence, old men and old women stand necessary surgical 
operations surprisingly well; and their tissues, under 
proper aseptic precautions, heal almost as surely and 
kindly, although somewhat more slowly than those of 
the young and middle-aged. 

Such diseases as attack old men and women run, as a 



THE PREVENTION OF OLD AGE 417 

rule, a milder course, produce less disturbance, and, 
with the exception of pneumonia, show almost as high 
a recovery rate as they do in adults, or in the young. 

An amusing illustration of this bouleversement in 
attitude is afforded by the gentle and unconscious ten- 
dency of most old men and women — indeed for the 
matter of that, most middle-aged ones as well — to 
give themselves airs of moral superiority, and pose as 
examples of deportment to the young. Having lost the 
sawmill, famine-like edge of their appetite, for both 
food and drink, and becoming more moderate and 
abstemious in their tastes, they are inclined to give 
themselves great credit for this reform of their habits, 
and to assure all the rising generation that, if they had 
only known enough to restrain their appetites when 
they were young, they would have avoided a great deal 
of trouble; and to hear them talk, they might have 
already reached the age of eighty, or eighty-five, 
instead of seventy. 

Now that they have reformed from necessity, they 
are sure they are going to live to be a hundred, and urge 
all their young friends and relatives to follow their 
example. In like fashion, having lost their ability to 
stay awake late at night, and usually waking up early 
in the morning, without being able to go to sleep again, 
they become proud of their habits of early rising and 
retiring in good season. 

If they have been of convivial, or uproarious 
habits in their youth, they, as a rule, lose the taste 
for these more exciting and violent pleasures, as well 
as the strength to indulge in them; and are apt quite 



418 COMMON DISEASES 

to plume themselves on their wisdom and self-control 
in abandoning such unprofitable habits. 

The quite unnecessary goodness of some of our stan- 
dards of morality unquestionably comes from the fact 
that these standards are largely established by the 
elderly and influential, or the old and venerable. This 
is one of the reasons why we believe such a lot of 
morality, and practice so little of it. Certainly, in the 
physical world, not a few of our most famous and 
most universally accepted rules of health have been 
written in, and for, the declining years of life, and ex- 
tended to, or even forcibly imposed upon, the ascend- 
ing years. Many, if not most, of the improvements 
that we would make in our conduct if we could become 
young and start life over again, would be ridiculous 
misfits. 

There was a delicious topsy-turvy wisdom in Lewis 
Carroll's "Alice in Wonderland " satire on callow youth 
eager to profit by the wisdom and example of ripe old 
age. 

" You are old, Father William," the young man said, 
" And your hair has become very white, 
And yet you so constantly stand on your head. 
Do you think at your age it is right ? " 

" In my youth," Father William replied to his son, 
" I feared it might injure the brain 
But now that I 'm perfectly sure I 've got none 
Why I do it again and again." 

The counsel of old age is very valuable — for the 
aged; but should always be taken with a large-sized 
grain of salt by youth. Few things could be more ab- 



THE PREVENTION OF OLD AGE 419 

surd than the despairing pessimism of the French 
philosopher, " Si lajeunesse savoit, si la veillage pouvoit " 
(If youth only knew, if old age only could) . If youth 
knew, it probably would n't; nor would old age if it 
could. They would both be better guided by their in- 
stincts. Even if youth did, it would probably make 
quite as many mistakes as improvements, and would 
lose one of the greatest pleasures in life, and charms 
of its age — the fun of finding out. Even if old age 
could, the desires and impulses of youth would be not 
merely as unbecoming and absurd, but as little attract- 
ive and even repugnant to them personally, as the 
habit of eating green apples, or standing on one's head. 

Old age and youth are different. Their conditions 
are different, their standards different; and to assert 
that one is happier, or less happy, than the other is 
irrational — indeed, little short of absurd. 

Another thing which has helped to mislead us in re- 
gard to the disabilities and discomforts of old age, is 
that we seldom realize to what a large extent these 
are, not merely removable, but have already been re- 
moved by the progress of modern science. Up to half 
a century ago, it was an accepted commonplace — an 
axiom almost — that the vision of the old became dim, 
their hearing poor; that they were chained to their 
chair and their fireside by rheumatism; that from the 
loss of their teeth they were compelled to live upon 
gruels and paps, and that, what with their dim vision 
and their poor hearing, and their feeble and tottering 
gait, unless they could hobble over to the hearthstone 
of some crony of their own age, they had no means 



420 COMMON DISEASES 

of keeping in touch with the life about them, and lost 
all interest in the affairs of the world. But we have 
changed all that, or most of that, already. 

The only important, or frequent, decline of vision 
which comes with advancing years is that due to the 
loss of power in the little muscle of accommodation, 
combined with the loss of elasticity in the lens, pre- 
venting the eye from adjusting itself for near vision. 
This gives rise to the familiar long-sight of middle and 
later years. But this mechanical disability can be en- 
tirely overcome for all practical purposes, by mechan- 
ical means, namely, the placing of lenses, or specta- 
cles, in front of the eye to do for it what its increasing 
rigidity renders it unable longer to do for itself. With 
properly adjusted spectacles, the vision not merely of 
the elderly and old, but even of the extremely aged, 
may be made, for all practical working purposes, as 
good as in youth. 

So that, with the wonderful development of the 
Black Magic of the printer's art, and the flood of well- 
written and beautifully printed and illustrated books 
and newspapers and magazines, upon every conceiv- 
able subject, and appealing to every possible range of 
interest, the old man in his well-warmed room, or 
sunny porch, can have pass in review before him, all 
the interests, activities, and thoughts of the world, 
the histories of the past, the excitements of the present, 
and the adventures and prophecies of the future. 

There is no longer the slightest reason to dread that 
any of us will fail of resources, or be in danger of losing 
an interest in life when we grow old. The only other 



THE PREVENTION OF OLD AGE 421 

degeneration which often occurs in the eye, the loss of 
transparency by the crystalline lens, producing the 
well-known cataract, does not occur in more than a 
small percentage, even of those who pass their seven- 
tieth year; and when it does occur, is susceptible of 
complete relief by a safe and painless surgical opera- 
tion. 

The same thing is true in an almost equally striking 
manner in the limitations of diet and impairment of 
mastication, due to the loss of teeth. Dental science 
has now reached a pitch where it can make the proud 
claim that if it be given charge of the teeth in child- 
hood, so as to be able to exercise preventive and pro- 
tective care over them, it can practically prevent decay 
of the teeth altogether, or postpone it to a much later 
period in life, than now customary. If decay has al- 
ready occurred,^so perfect have become the resources 
of the dental art in the direction of filling and crowning 
and bridging, that efficiency can be preserved to an 
almost unlimited degree and period; even if worst 
comes to worst, a clean sweep can be made of such 
pitiful remnants as remain, and fair, moderate com- 
fort and good masticating power given with the plate, 
or full set. 

Unfortunately, we still lack a cataract operation for 
the ear, or a device which will cause sound waves to 
reach the nerve keyboard of the inner ear, as spectacles 
will cause the light waves to focus upon the retina. 
But we have discovered the encouraging fact, that 
instead of the impairment of hearing of middle life and 
old age being due to a mere inevitable dulling of the 



422 COMMON DISEASES 

senses, to some degenerative process in the nerve of 
hearing due to old age, the overwhelming majority of 
deafness which we find is due to an inflammatory dis- 
ease of the middle ear, and the changes which result 
from this. Successions of neglected bad colds, un- 
treated chronic catarrh, spreading up the tiny Eu- 
stachian tube from the back of the throat to the cavity 
of the ear, thicken the drum and bind together the 
tiny chain of bones behind it, and thus cause some- 
thing like ninety per cent of all cases of deafness. It is 
not old age that causes "all the daughters of music to 
be brought low," but catarrh. 

It is not too much to say that when teeth are kept in 
perfect condition, and ears and noses kept free from 
catarrh by pure air and the avoidance of infectious 
germs, and their diseases promptly treated and cured 
before they can creep up the Eustachian tube and 
attack the ear, that, with the boon of spectacles, three 
fourths of the so-called dimming of the senses of sight, 
hearing, and taste in old age, will have been done 
away with. 

Even though "the almond-tree shall flourish" and 
the "strong men bow themselves" and "they shall 
wake up at the voice of the bird," the sun need not 
become darkened, nor the "grasshopper become a 
burden," nor desire fail, nor life ever appear a vanity 
of vanities. The preacher who chanted that swan- 
song was — like many another mournful moralist — a 
reformed rake, who only, in Renan's cynic phrase, be- 
came virtuous when he found himself impotent. Only 
a sadly misspent youth brings this kind of an old age. 



THE PREVENTION OF OLD AGE 423 

The outlook in regard to the various crippling dis- 
abilities of old age is almost equally cheering. While 
there is, unquestionably, loss of power due to actual 
shrinkage of the muscle cells themselves in old age, 
and some loss of balancing power, from similar changes 
in the brain, and particularly the cerebellum, this is a 
change only in degree, rather than in kind; and the 
man who through adult and middle life keeps himself 
in the habit of vigorous, enjoyable, and abundant 
exercise in the open air, will find that he can continue 
this in milder forms, and within somewhat more re- 
stricted limits until he is seventy-five, eighty, or 
eighty-five years old. Not a few of the crippling mus- 
cular disabilities of old age are due to bad habits 
and over-confinement, and too much sitting still in 
middle life. 

At the same time, we have found out that the vast 
majority of the changes in muscles, joints, and bones, 
which take place in old age are not only gradual and 
symmetrical, but absolutely painless; and that where 
actual laming of a joint, or pain in a limb, occurs, these 
are, nine times out of ten, the result of rheumatism, or 
some other form of some acute, infectious disease. In 
other words, most of the positive, and all the painful 
muscular and locomotor, disabilities of old age are due 
to diseased conditions. Many of these diseased condi- 
tions are already preventable; still more are curable, 
and all are becoming more so every day. So that the 
outlook for physical comfort in the later j T ears of life 
is already excellent and steadily becoming better. In- 
deed, that most characteristic and fundamental of all 



424 COMMON DISEASES 

senile degenerative changes, the slow dry decay and 
hardening of the muscular coat of the arteries, known 
as arteriosclerosis, has recently been found to be chiefly 
hastened, if not actually largely caused, by two influ- 
ences, muscular overwork and infectious disease, both 
of which are in measure avoidable, either by the indi- 
vidual himself, or with the aid of the community and 
its laws. The pitiful feebleness and decrepitude of the 
aged laborer are due not to his age, but to the cruel 
overwork that has wasted his muscles and stiffened his 
arteries, the diseases of overcrowding and foul air that 
have burned up his vitality before his prime, the scanty 
diet and bad food which have undermined his strength 
and robbed him of resisting power. We cannot prevent 
the approach of old age, nor even at any time arrest its 
course, but we can delay its progress and rob it of three 
fourths of its terrors. Don't work too hard, where you 
have choice in the matter; live, sleep, and spend plenty 
of time in play in the open air; avoid in every feasible 
way exposure to infectious disease; keep a good appe- 
tite and gratify it three times a day; keep up your 
interests and hobbies, especially outdoor ones, and 
you'll never realize that you're old until after you're 
dead — and then of course you won't. 

In a score of less direct ways modern progress has 
done much to increase the enjoyableness of the later 
decades of life. A hundred years ago, for instance, the 
easiest and swiftest way of travel was by stage coach, 
and fifty miles a day for five days in succession was 
about the limit of physical endurance for the strongest 
and most robust man in the prime of life. Now, any one 



THE PREVENTION OF OLD AGE 425 

who is able to walk the length of his garden unaided, 
can travel the whole circuit of the globe with comfort 
and delight. All he has to do is to step from a station- 
ary living-room, dining-room, or bed-room, into a 
moving one; and he can literally be carried from one 
end of the country to the other sitting in his easy 
chair, without discomfort and without fatigue. While 
to those who are fortunate enough to be able to afford 
it, the automobile has restored the agility of their lost 
youth, multiplied ten-fold, like some fabled Seven 
League Boots. No gruel in the chimney corner for 
them, while a seat on the Magic Carpet of the twen- 
tieth-century motor-car is to be had. 

The decade or two after retirement from the more 
active cares of life, instead of being the decade of con- 
finement to house and garden, with meditation and 
prayer as its chief resource, has become a decade of 
travel, of seeing the world, of getting a broader outlook 
upon life. 

Even such a prosaic change as the vast improve- 
ments in our method of heating our houses, has liber- 
ated old age from many of its shackles. Poets have 
been fond of describing old men and old women as 
"chained to the hearth," "living in the chimney 
corner," "stretching out their thin and gnarled hands 
to the leaping flames." But this was simply because 
the chimney corner, or place immediately near the fire, 
was the only place in the whole house that was decently 
warm. Even it was warm only on one side. The "old 
bones that were hard to please" at night, and made 
sleep a difficulty, owed most of their grumblings to 



426 COMMON DISEASES 

the fact that the unwarmed, or poorly warmed bed- 
room, combined with the lessened internal heat pro- 
duction, caused them to be loaded down with not 
merely oppressive, but almost crippling, weights of 
blankets and counterpanes. 

With the good air indoors, that can only be got 
where good modern methods of heating are employed, 
the old man loses half his tendencies to the colds and 
rheumatic attacks that cripple him, and the pneu- 
monias that may ultimately carry him off. He can sit 
anywhere that he pleases in the room, or move about 
all over the house without danger of chilling his old 
bones; and his tendency to become bent and cramped 
and stiffened will be diminished more than one-half. 

In another way, also* old age is, in these days, re- 
lieved from much of its bondage to cold, and the win- 
ter's storm, by the possibility of making a change of 
climate, and following the sun down toward the equa- 
tor in winter time, at moderate expense and without 
fatigue, or discomfort. The possibility of wintering in 
California, or Florida, under even the most modest cir- 
cumstances, gives a new lease of life to those in declin- 
ing years. One of these days when we become suffi- 
ciently civilized, the possibility of a change of climate 
in winter for those who have turned their backs upon 
the sun, will be looked upon not as a luxury, but as a 
necessary comfort to which they are legitimately en- 
titled, and which will be placed within their reach by 
the community, or the state. 

In short, instead of a disease, the tendency of mod- 
ern science is more and more to regard old age as, not 



THE PREVENTION OF OLD AGE 427 

merely a necessary, but a normal, painless, and even 
enjoyable, condition. Like all normal processes, it is 
not merely painless, but even desirable, when the time 
comes, like death itself. This is strongly supported by 
such studies as have been made of the essential charac- 
ter of the changes that take place in old age. 

The first thing that stands out with surprising dis- 
tinctness is that there is nothing new about these 
changes. That instead of their being limited to, or 
even beginning definitely at, a certain moderately 
advanced age of life — forty, fifty, or sixty years — 
they are a continuation of changes which have been 
going on steadily from childhood, yes, from birth. 

If we are going to do anything to cure the disease of 
old age, we must begin before birth. Indeed, as Oliver 
Wendell Holmes wittily remarked on the prevention 
of disease, "with the grandparents." The so-called 
senile changes are changes which have been going on 
ever since we began our individual existence as a fer- 
tilized ovum. The time when we begin to feel old, the 
particular period at which we begin to " show our age," 
is merely that period at which these internal changes 
have reached and shown themselves upon the surface, 
in which, so to speak, these microscopic alterations 
have finally become visible to the naked eye. 

It is nothing short of absurd to say that a man be- 
comes old, or senile, or incapable of further develop- 
ment, or of the conception of new ideas at, or after, any 
special or particular age. There is no one period of life 
in which we grow and another in which we decline. 
Both processes are going on side by side in every part 



428 COMMON DISEASES 

of our body from the day we are born. Just as the life 
of the body means the death of certain of its cells, so 
the growth of every power and faculty means the 
sacrifice and the decay of others. Every primitive cell 
of the embryo lays down part of its life to become a 
muscle-cell, a neurone, a blood-corpuscle or a bone cell. 
The youngest and pulpiest fibre in a baby's muscle, 
the most primitive nerve-knot that lays the founda- 
tions of the brain, is in and by that process beginning 
to be old. Division of labor among the cells to form 
a body, differentiation, as the biologists term it, is the 
livery of death. Only one-celled animals which have 
no differentiation, are immortal and never grow old. 
Physical immortality, deathless youth, is possible, but 
you must be an infusorian or a yeast-plant to attain 
it, and one would n't even be a clam or a jelly-fish for 
the price. 

The process has no limits any more than it has 
beginnings. Life is just that, one third dying that 
two thirds may live, whether it be the single cell, or the 
hugest and most elaborate body. While in such gross 
matters as mere avoirdupois and stature, and the 
actual horse-power of our muscles, we reach a limit, a 
period of what we are pleased to call maturity, at a 
comparatively early age, yet in other and more impor- 
tant respects we continue to grow and develop steadily, 
to a very much later period — fifty -five, sixty, and even 
seventy years. New and valuable achievements, mas- 
terpieces in every realm of human activity and inter- 
est, have been produced hundreds of times in every 
decade, up to and including the ninth. 



THE PREVENTION OF OLD AGE 429 

Indeed careful studies and measurements have 
shown that our time of actual maturity and arrest of 
growth in physical characters, such as height, weight, 
and chest girth, is much later than formerly supposed; 
and instead of reaching, as was at one time confidently 
stated, our full height at eighteen, our full strength at 
twenty -three, and our full chest girth at twenty -five, 
as a matter of fact, we continue to increase, slowly, it 
is true, but definitely, in all these respects until thirty- 
five, thirty-eight, and even forty years of age. 

It is obvious then that there is no hard and fast 
"dead line" which can possibly be drawn, beyond 
which no further growth, or fresh creative effort, or 
new enterprise, or improvement, is possible. In fact, 
by living a healthful, active, happy life, and keeping 
up all our interests, we can grow and develop and 
adjust ourselves, and feel that we are growing, until 
we are one day suddenly dead, without ever realizing in 
any distressing or painful way that we are growing 
old at all. 

Indeed, old age has already gone quite out of fashion. 
The civilized, educated man or woman of seventy is 
younger than the savage of forty or the peasant of 
fifty. What with steady spread of regular vacations 
and country or surburban homes, and walking clubs 
anpl golf and gardens and automobiling and travel 
of all sorts, those who would once have been con- 
sidered old, are now only seventy or seventy -five years 
young. 

Not only is there no definite period in adult or later 
life when these so-called senile changes begin, but there 



430 COMMON DISEASES 

is no period at which they become accelerated or start 
to progress at a more rapid rate than before. In fact, 
the extraordinary paradox exists that what we term 
old age, is the time of life in which we are growing old 
least rapidly. The only thing that makes it appear 
otherwise is that we have been steadily growing old all 
our lives long, and the thousand imperceptible accum- 
ulations have mounted to a height that we can recog- 
nize. 

It was only within the last quarter of a century that 
we actually sat down to quietly and rationally discover 
in just what this loss of youth consisted, and at what 
period any steps for its relief must be taken. Few 
things are more amusing — I had almost said infantile 
— in the history of the human mind than the eagerness 
with which we have seized upon one straw discovery 
after another of the cause of old age; or even of the 
special change which constituted old age, and the 
prevention of which would abolish, or arrest, it. At 
first it was supposed to be certain arresting and cal- 
cifying changes in the bones; and a variety of bone- 
building foods were recommended which would pro- 
long youth indefinitely. Then it was certain changes 
in the muscles, or the wasting away of certain cells in 
the brain^ or that curious decay and stiffening of the 
muscles in the walls of the heart and blood vessels, 
known as arteriosclerosis, which gave rise to the famil- 
iar proverb, "A man is as old as his arteries"; and 
which was the underlying process of old age. 

Then almost every organ of the body was taken up 
in turn, and separately accused of being the criminal 



THE PREVENTION OF OLD AGE 431 

that, by its premature decay, poisoned the rest of the 
system, and produced old age. Particularly was this 
the case with those organs of whose use and function 
we were still ignorant, and which, therefore, left limit- 
less room for speculation without risk of successful 
contradiction, such as the thyroid gland, the supra- 
renal body, the thymus gland, and even the tonsil, 
or appendix. 

As our knowledge of the body, and means of its more 
elaborate study, increased, our guesses became more 
profound and complicated, but scarcely more rational. 
MetchnikorT discovers that at a certain stage in the 
process of decay, a form of large white blood cor- 
puscles, which he terms macrophages, appear in the 
organs that are undergoing senile decay, and proceed 
to attack and devour their substance. For instance, 
they attack the pigment, or coloring matter, in the 
shafts of the hair, and thus produce the familiar 
blanching, or graying, of old age. Whereupon he an- 
nounces that these deadly and treacherous macro- 
phages are the real causes of old age and all its dis- 
abilities. 

Going a step further, he discovers that what ap- 
pears to endow these macrophages with their mur- 
derous tastes and powers, is putrefaction in the in- 
testines due to the presence of bacteria. The region 
which contains most billions upon billions of bacteria 
is the lower section of the bowel, known as the large 
intestine, therefore this large intestine, with the putre- 
factions which take place in it, is the cause of old age. 

At first he was content to endeavor to diminish these 



432 COMMON DISEASES 

putrefactions, by the administration of sour milk, on 
the theory that the lactic acid produced in sour milk 
had the power of checking the growth of putrefactive 
bacteria. So far his position had been pure and harm- 
less theory, and he needed some point at which his 
rainbow could rest upon the earth; and was fortunate 
enough to find it. 

Happening to spend a couple of summer vacations 
in the Caucasus Mountains, he discovered two startling 
facts, that in the tiny hamlets which dotted the glens 
and the passes, there were large numbers of very old- 
looking people, many of whom claimed to be centena- 
rians; and the inhabitants of these same villages used 
large quantities of sour goat's milk. Nothing, of 
course, could be clearer than that the sour goat's milk 
caused the centenarian; and a new cure for old age was 
discovered, and proudly proclaimed, namely, sour milk 
and clabber cheese. 

Of course, it was quickly pointed out that sour milk 
and cottage cheese were articles in common household 
use all over the civilized and uncivilized world; and 
that many peoples who were most addicted to them 
reached the mature average longevity of a little over 
twenty years; that the alleged centenarians of the 
Caucasus had, like most other centenarians, no proof 
of their real age; that there was no proof that the 
swarms of bacteria in the large intestine were in any 
way injurious to the system, or had any connection 
whatever with the macrophage, or that the most mur- 
derous macrophage could make the slightest impres- 
sion upon young and vigorous tissues and organs. • 



THE PREVENTION OF OLD AGE 433 

Furthermore, laboratory tests showed that the 
bactericidal power of lactic acid was of the mildest 
and feeblest, and that sweet milk would produce al- 
most the same amount of lessening of the number of 
bacteria in the large intestine as the best imported 
Bulgarian bacilli. We have all been, more or less, on 
the sweet-milk treatment from a very early age. 

But something must be done to save the theory, and 
therefore, casting aside the splintered remains of his 
lactic acid spear, he boldly attacked the entire large 
intestine with a club, figuratively speaking, demanding 
its utter and complete annihilation and removal from 
the body. A few eager-eyed seekers after health and 
immortality, and followers of the new fads, submitted 
themselves, or their patients, to this wholesale ampu- 
tation; but the results were not entirely satisfactory. 
Although the new Immortals would, unquestionably, 
have lived to be very old — if they had survived the 
operation — a good many of them were inconsiderate 
enough not to do this; and at least two thirds of the 
survivors were left in such condition that they wished 
they had not. But still, there will doubtless be an 
eager jump for the next "Sure Cure for Old Age.'* 

In fact, all these explanations and cures have shared 
the same fate, namely, that the single changes in sepa- 
rate tissues, or organs, upon which they depended, were 
all found to be merely local expressions of the general 
process of degeneration which was going on all through 
the tissues. All the changes that caused old age were 
merely symptoms of the process itself, like the whiten- 
ing of the hair, and the shrinking of the gums. Not 



434 COMMON DISEASES 

only would no one of them alone produce old age, but 
the arrest, or cure, of no one of them alone would 
prevent it. 

Careful post-mortem examinations of the bodies of 
those dead of old age showed hundreds of cases of per- 
fectly soft, elastic arteries, of normal thyroids and 
suprarenals, of unblanched hair, of undecayed teeth, of 
unwasted bone, and unatrophied muscles. And yet the 
curtain had fallen upon the final scene, nevertheless. 

For many centuries we contented ourselves with the 
superficial belief that the changes which produce old 
age were something which began in, and were peculiar 
to, middle or later life, and therefore, with childish 
naivete, we were confident that something could be 
done, or would one day be discovered, which if applied 
at this time of life would do something to arrest them, 
and prevent old age; or even with flatulent absurdity 
and credulity, restore our youth. All literature and 
legend are full of eager, pathetic quests for some fabled 
Fountain of Eternal Youth. Indeed, the discovery of 
the Mississippi River and the best part of our country, 
was due to such a search. 

The only things that need make us dread old age are 
poverty or disease. Both of these are preventable, and 
in the process of prevention. The man or woman who 
in seventy honest, hard-working years has not ren- 
dered the world abundant service to justify an honor- 
able retirement, with a liberal support, is a rara avis 
indeed. That the conscience of the community is al- 
ready awake to the inestimable debt which it owes the 
veterans of life's battles, who have created its pros- 



THE PREVENTION OF OLD AGE 435 

perity and made its very existence possible, is already 
shown by the almost world-wide establishment of 
schemes for old-age pensions, though these ought not 
to be necessary in a community where every man is 
given his fair share of the wealth that his hands and his 
brain have produced. We pay millions upon millions 
every year, without stint or grudge, to pension in their 
declining years our old soldiers, those who offered their 
lives and shed their blood for their country. But every 
worker who is enlisted in the great industrial army of 
servants of the common good, he too has not merely 
offered but spent his life, aye, and shed his blood in our 
service. For us his back was bowed, his muscles stiff- 
ened, his brow furrowed with anxiety and carking care, 
his hands calloused and gnarled. It is only the dull 
scales of use and wont over our eyes, only his every- 
day commonness and frequency, that blinds us to the 
heroic aspect of the patient, pathetic figure of the 
aged toiler, who has faced every day and every year 
of his life, in mine, in blast-furnace, in factory, in yard 
and siding, risks as deadly as any upon the field of 
battle. As Kipling, in his splendid hymn to labor, sings : 

"Pierce ye the mountains, bridge the flood," 
Make ye the path more broad and flat, 
Nay, it is black already with blood 
Some Son of Martha shed for that. 

"Early at dawn ere men see clear. 

They stumble into Death's terrible stall 
And lead him forth like a haltered steer, 
And turn him and goad him till evenfall." 

Not for himself, but for the Life of the Race, for bread 






436 COMMON DISEASES 

and shelter for his wife and little ones. And the 
woman who works, whether in the home or outside it, 
she too has worn out her powers, has spent her all for 
the service of the race. She too has offered her life and 
shed her blood to bring into the world the new genera- 
tion. There has been more blood shed in the birth- 
chamber than ever upon the field of battle, ye who 
would belittle woman because she cannot offer her 
life in defense of her country! Never can the race 
repay the debt it owes to the aged nor will it refuse 
gladly and proudly to acknowledge it. 

Every man is entitled to live as long as he can 
live usefully, wholesomely, and happily. Whenever 
he reaches the point where he feels he can no longer do 
either, he has the right to hand in his resignation and 
depart in peace without censure and without reproach. 
Though the advancing years bring us nearer death, 
this adds not one iota to their terrors. As in youth 
there is an instinct for life, in old age there is an in- 
stinct for death; and all develop it who live long 
enough. 

Though the thought of death falling like a shadow 
across our path, chills and repels us in the flush of 
youth or the hot noon of manhood's prime, there is a 
time to die as well as a time to live. Work-worn and 
pain-weary men and women stretch out their arms to 
the Great Rest-Bringer and long for death, as little 
children cry for sleep at eventide. Death is a peaceful 
ceasing to be, far less strenuous than birth, painless, 
natural, like the fading of a flower or the falling of a 
leaf. 



THE PREVENTION OF OLD AGE 437 

The physician sees scores and hundreds of men and 
women in the Valley of the Shadow, and rarely, very 
rarely, one who is afraid or even keenly unwilling to die 
when the time comes. That men are afraid to die when 
their time comes, is one of the many slanders upon 
humanity by superstition and its priests. When Death 
comes near enough so that we can see the kindly eyes 
behind the mask, his face becomes as welcome as that 
of his twin-brother, Sleep. 



THE END 



INDEX 



Abernethy, John, 69. 

Abscess in the liver, 117. 

Adenoids, 278. 

Adipose, encumbering excess of, 
very rare, 47, 48; treatment of, 
56 jf., 61, 62; causes of, in the 
young, 58-60; laziness and 
gluttony rarely responsible for, 
60; prevention of, 61, 62; dan- 
ger or worthlessness of patent 
cures for, 63, and of changes of 
diet, 64, 65. And see Obesity. 

iEsculapius, woman the oldest 
priest of, 3. 

Air, in the nose, 126, 127. 

Air, fresh, in catarrh, 133, 134, 
138; and insomnia, 369, 373. 

Albumen in urine, 171 ; in Bright's 
disease, 176-178; in infectious 
diseases, 178. 

Alcohol, the first patent medicine, 
4; discovery of, 7; in household 
remedies, 13; and the liver, 
105, 106; in arteriosclerosis, 
184, 185, 237; in sea-sickness, 
263, 264. 

Alimentary canal, disturbance in, 
and dyspepsia, 92, 93. 

Aloes, 34. 

American, the typical, 119; as a 
family man, 197, 198. 

American digestion, the, fallacies 
concerning, 66 ff. 

Amputation of limbs, delusions 
concerning, 395 ff. 

Angina pectoris, 239, 240. 

Animals, tests of drugs on, 16, 21 ; 



and sea-sickness, 254, 255; as 
sleepers, 352. 

Anopheles (mosquito), 335, 336. 

Antibodies. See Antitoxins, nat- 
ural. 

Antiseptic sprays and washes, 
280. 

Antiseptics, invention of, 18; 
their utility in medicine how 
limited, 18; intestinal, 17. 

Antitoxins, function of, in fevers, 
19; immunity from second at- 
tack how provided by, 26; dif- 
ficult to procure, except in 
diphtheria, 21. 

Ants, bites of, 347, 348. 

Aorta, the, 238, 239. 

Apoplexy, 241, 242. 

Appendicitis, and dyspepsia, 92, 
93; "referred" pain in, 394. 

Appendix, 431. 

Appetizers, 89. 

Aromatic oils for mosquito bites, 
345. 

Arsenic. See Salvarsan. 

Arteries, breaking down of mus- 
cles in walls of, 236; plugging 
of, 242. 

Arteriosclerosis, in kidney dis- 
ease, 183, 238; causes of, 184, 
185, 236/.; 26, 424, 430. 

Asthma, characteristics of, 140j|f., 
143, 144; a "neurotic" disease, 
143; lack of knowledge of, 143; 
seldom fatal, 145; and con- 
sumption, 146, 147; "hives in 
the lungs," 148; allied to hay 



440 



INDEX 



fever, 157, 158; paroxysms of, 

158-160; treatment of, 162/.; 

irritating causes of, 164, 165; 

374. 
Asthmatics, susceptible to other 

troubles, 147, 148; sufferings 

of, 158 ff. ; likely to live long, 

161. 
Astrologers, 7. 
Atrophy, brown, of the heart, 

240. 
Auditory nerve, 267, 268, 270, 

271, 282, 283. 
Auerbach's plexus, 77. 
Augurs, Roman, and the liver, 

96/. 
Automobiles, 425. 

Bacilli, of antitoxins, inoculation 
by, 20, 21; in the soil, 317. 

Bacilli-carrying insects, 333. 

Bacteria, discovery of, 18; in the 
body, 19; in diseases of the 
liver, 103, 104; in baldness, 
212; in the large intestine 
(Metchnikoff), 431, 432. 

Baldness, dread of, 199, 209; nat- 
ural, and premature, 201, 202; 
and brains, 202-204 ; and head 
gear, 205; why more common 
among men, 206 ff.; often 
hereditary, 211; bacteria as 
cause of, 212; no known way 
of arresting, 213, 215; futility 
of remedies for, 213, 214; pre- 
vention the best cure, 215. 

"Barefoot," 313, 320, 321, 323. 

Bath, cold, in catarrh, 133, 138. 

Bees, stings of, 347, 348. 

Bile, yellow remedies for disturb- 
ances of, 18; secretion of, by 
the liver, 101, 102; color of, 
114; 98, 99. 

Bile duct, the, 114, 115. 



Biliousness, how to avoid, 106, 

107; 103. 
Birds, and sea-sickness, 255. 
Black cat, the, 8, 9. 
Black death, 317, 327 ff. 
"Black death of the liver," 109. 
Black pills, 8, 9. 
Blood, the, and plants with red 

juice, 8; circulation of, and the 

heart, 221, 222. 
Blood cells, white. See Leuco- 
cytes. 
" Blood medicines," 25, 27. 
Blood poisoning, 109, 224, 317, 

322, 334. 
Blood-vessels, over-nutrition of 

muscles in, 235, 236. 
Body cells, function of, 19; can 

live only in water, 126. 
Boer War, typhoid vaccine first 

extensively used in, 24. 
Boerhaave, Hermann, 17. 
Boils, vaccine for, 25; 334. 
Boots, and the foot, 292, 295; 

proper material of, 309, 310. 

And see Footwear. 
Boots, tight, as cause of flat foot, 

302, 307, 308; 289, 291. 
Bowels of compassion, 98. 
Bradycardia, 244. 
Brain, the, genesis of, 74, 75; in 

sea-sickness, 207; abscess on, 

275. 
Brain-fag, in insomnia, 367. 
Bright, Richard, 170, 171. 
Bright's disease, 170/.; progress 

of, 173, 174; no positive cure 

for, 174; modern treatment of, 

176/.; often follows infectious 

fever, 179; diet in, 180, 181; 

prevention of, in early stages, 

169. 
Bubonic plague. See Black death. 
Bunions, 289. 



INDEX 



441 



Caffeine, 34. 

Caius Metellus, 315. 

Canals, semicircular, disturbance 
of, in sea-sickness, 249 ff. 

Cancer, and clover tea, 8; possi- 
ble cause of, 26; liver as site of , 
118. 

Carlyle, Thomas, on the Ameri- 
can digestion, 66. 

Carpet-makers' catarrh, 125. 

Carroll, Lewis. See Dodgson. 

Cataract, 268, 421. 

Catarrh, and dyspepsia, 92; sup- 
posed prevalence of, in Amer- 
ica, 119, 120; causes of, 121, 
123, 124, 126, 128, 134; de- 
creasing, 121; defined, 121, 

• 122; distribution of, 123, 124; 
in divers trades, 124, 125 ; 
functions of nose in, 125, 126; 
chronic, 128; secondary effects 
of, 128, 129; prevention of, 
130 ff.; lowering of vital tone 
in, 132; the skin in relation to, 
133; nose-deformity a cause of, 

134, 135; generally harmless, 

135, 136; treatment and cure 
of, 137-139; 422. 

Caterpillars, 348. 

Cathartics, 5, 14, 15, 17. 

Cave Men, 325. 

Centenarians, mostly mythical, 
411, 412. 

Cerebro-spinal meningitis, anti- 
toxin of, 22; 21, 272. 

Cheese, cottage, and old age, 432. 

Childbed fever, 109. 

Childhood, healthy, the best 
preparation for happy old age, 
408. 

Children, diseases of, and old age 
"symptoms," 407, 408. 

Chloral, 373. 

Chloroform, 373. 



Cholera, 317. 

Cholera morbus, 334. 

Clark, Sir Andrew, 147, 148. 

"Clean heart, a," 98. 

Cleanliness of food, 86, 87. 

Climate, change of, in asthma, 
162, 163; in old age, 426. 

Clots of blood, in arteries, 242. 

Clover tea, as a cure for cancer, 
8, 43. 

Coca, 14. 

Cocaine, in asthma, etc., 154, 155. 

Cochlea, the, 270. 

Coffee, 243. 

Colds, common, vaccine treat- 
ment of, 25; cannot be caught 
in open air, 130, 131; as cause 
of deafness, 266 /., 275, 276, 
278; cause many diseases, 279; 
precautions against, 280; 178, 
224, 225, 409, 413. 

Color, and curative power, 8, 9. 

Consciousness, in sleep, 353, 354, 
355. 

Consumption, increase of weight 
in, 52, 53; and asthma, 146, 
147; 125. And see Tuberculosis. 

Cook, Frederick A., 130, 131. 

Cooking, why invented, 85. 

Cooling lotions for mosquito 
bites, 345. 

Corns, 289, 291, 307, 308. 

Coronary arteries, 231, 238, 239, 
240. 

Country life, 330/. 

Cow, toes of the, 325. 

Cretinism, 26. 

Darning, 310, 311. 
Darwin, Charles, 260. 
Darwinian theory, 4. 
"Dead-Shot, The," 33. 
Deafness, and catarrh, 129; diffi- 
culty of curing, 265 ; prevention 



442 



INDEX 



is possible, 265, 266; colds as 
cause of, 266; most cases arise 
in ear-drum, 272 ff.; thickening 
of drum, 275, 276; scarlet fever 
and, 277; in adenoid children, 
278; fresh air the best preven- 
tive of, 278; caused by blocking 
Eustachian tube, 281; instru- 
ments for relief of, 283; fre- 
quency of, 283, 284; never pro- 
duced by noise, 287; in old age, 
408, 421, 422. 

Death, general dread of, 405; 
nature of, 406, 436, 437. 

Death-rate, comparative, in in- 
fancy and old age, 413. 

"Decline" of powers in old age, 
414, 415. 

Demoniac possession, 32. 

Depression, in sea-sickness, 256. 

De Quincey, Thomas, 364. 

Diabetes, cause of, 26. 

Diaphragm, the, 240, 248. 

Diarrhoea, 117, 224, 225. 

Dickens, Charles, 67. 

Diet, in obesity, 64, 65; in 
Bright's disease, 180. 

Digestion, conversion of foods 
and poisons in, 106. 

Diphtheria, antitoxin of, 21; 
diminishing death-rate from, 
169; 109, 178, 224, 279. 

Disease, progress in knowledge of, 
15; change in treatment of, 15; 
prevention or cure? 28; earliest 
conception and treatment of, 
32; generally marked by ema- 
ciation, 54, 55. 

Diseases, and remedies, fanciful 
connection between, 9. 

Doctors, drugs discovered before 
invention of, 7; their progress 
in knowledge, 15. And see 
Medical Profession. 



Dodgson, Charles L., 418. 

Dog, toes of the, 325. 

Drug problem, one of oldest in 
history, 3. 

Drugs, antedate doctors, 4, 7, 11; 
how discovered, 4 ff.; most 
standard drugs discovered be- 
fore dawn of history, 7; method 
in testing, 7, 8; unnecessary in 
great majority of illnesses, 11, 
12; "trans valuation of values" 
as applied to, 12; oldest and 
most used, are most dangerous 
and poisonous, 12^".; progress 
in knowledge of, 15; old confi- 
dence in, has vanished, 16; 
tests of, on animals, 16; reduc- 
tion in number of useful, 16, 
17; the "real" drugs, 17; only 
three will cure disease, 17; 
present and future use of, 29, 
30; to produce sleep, 373. 

"Dry diet," 234. 

Dryness of the air, and catarrh, 
124. 

Dunbar, Professor, 155, 156. 

Duodenum, ulcers in, and dys- 
pepsia, 93. 

Dysentery, 112, 117, 224, 334. 

Dyspepsia, 66 ff.; how distin- 
guished from indigestion, 80; 
principal causes of, 89 jf.; sup- 
posed prevalence of, in Amer- 
ica, 119, 120. 

Ear, genesis of, 75; in catarrh, 
129; parts of, 269, 271. And see 
External Ear, Internal Ear, 
Middle Ear. 

Earache, 129, 273, 277, 278. 

Eardrum. See Middle Ear. 

Ear trumpet, 283. 

Eczema, 122. 

Ehrlich, Dr., 18. 



INDEX 



443 



Emaciation, characteristic of 
most diseases, 54, 55. 

Emetics, 5, 14, 15, 17. 

Endocarditis, 223, 242. 

Enzymes, 25, 26. 

Epilepsy, nitrate of silver as cure 
for, 10, 11. 

Equilibrium, disturbance of, in 
sea-sickness, 247, 249 /.; and 
in other cases, 256, 257. 

Eustachian tubes, in catarrh, 129, 
135, 136; 266, 272, 273, 277, 
278, 281, 422. 

Exercise, in excessive obesity, 
57, 58, 61, 62; dangers of vio- 
lent, 62; lack of, as cause of 
dyspepsia, 89, 90, 91 ; for weak 
hearts, 229, 232, 237; lack of, 
and insomnia, 369, 373; in old 
age, 423. 

Expectoration, in America, 69, 
70. 

External ear, 269, 271, 272, 285. 

Eye, genesis of the, 74; changes 
in, in kidney disease, 173; in 
sea-sickness, 252. 

Eye-strain, and dyspepsia, 91. 

Families, of imaginary invalids, 
391, 400, 401. 

Fashions, in disease, 387, 390, 
391. 

Fat, importance of, 48-50; 
"around the heart," 55, 56. 
And see Adipose. 

Fatigue, causes of, 190, 19^, 
a symptom of self-poisoning, 
232; and insomnia, 367. 

Fatigue-poisons, how to get rid 
of, 190, 191; 232, 233. 

Fatness. See Adipose, and Obes- 
ity. 

Fatty heart, 56, 241. 

Fermentation, 6, 7. 



Ferments. See Enzymes. 

Fevers, processes of, described, 
19. 

Filters, in the body, 167/. 

Fish, and mosquito larvae, 340. 

Flat foot, 289/.; not congenital, 
302; causes of, 302/.; in out- 
door occupations, 304; preven- 
tion of, 305 /. 

Fleas, transmission of bubonic 
plague by, 328. 

Flexner, Simon, 22. 

Flies, 331, 332, 333. And see 
House fly. 

Flowers. See Plants. 

Food, relation between fatness 
and, 51; should be clean, 86; in 
kidney diseases, 179, 180; im- 
portance of, in heart disease, 
234; of no account in sea- 
sickness, 248, 249. 

Food fads, origin of, 84. 

Food inspection, importance of, 
86. 

Foods, digestibility of, 80, 81; 
fuel- value of, 81; why they 
disagree with us, 81, 82; con- 
verted into poisons by the 
liver, 106. 

Foot, the, responsibility of, 288, 
289; of the horse, 290 /.; ex- 
pansion of, how hindered, 294, 
296; results of maltreatment of, 
297, 298; breaking down of 
arches, 299, 300, 301; skin of, 
as a gate of infections, 316, 317; 
and the hookworm, 318-320. 

Foot, bare, 313, 314, 320/. 

Foot, flat. See Flat foot. 

Foot failure and heart failure, 
288. 

Footwear, 295/; of women. 208. 
299; as cause of flatfoot. 299, 
300; early use of, 314, 315; uni. 



444 



INDEX 



versality of, explained, 315, 

316; sometimes abused, 323 jf.; 

benefits of, 326 ff. And see 

Boots. 
Foramen ovale, persistent, 244, 

245. 
Formic acid, 348. 
Fountain of Youth, the, quest 

for, 434. 
Frederick the Great, 406. 
Fur-workers' catarrh, 124. 

Gall-bladder, 97, 115. 

Gallstones, and dyspepsia, 93; 
114, 115. 

Gastralgia, 91. 

Gastric catarrh, 122. 

Gastric juice, in dyspepsia, 90. 

Gastritis, 122. 

Gentian, 34. 

Germ-killers. See Antiseptics. 

Germs, in indigestion, 86, 87; as 
a cause of catarrh, 123, 125, 
130, 131, 132. And see Bacteria. 

Germs of disease, inoculation by, 
23. 

Glandular extracts, 27. 

Gnats, 331, 332, 333, 336. And 
see Simulium. 

Goiter, 26. 

Gold, supposed therapeutic pro- 
perties of, 11. 

Gold cure, the, 11. 

Gout, and uric acid, 182; diet in, 
182. 

Grant, Ulysses S., 68, 390. 

Growth, when arrested, 429. 

Hair, the, uselessness of, 200; 
premature loss of, 200 j/f. ; orna- 
mentation, its chief function, 
207, 208; loss of, in poor health, 
211, 212; rules of health for, 
216-218. And see Baldness. 



Hair-restorers, 214, 215. 

Hammer toes, 325. 

Hasheesh, 14. 

Hats, and baldness, 205, 217, 218. 

Haunted houses, 381. 

Hay fever, a "neurotic" disease, 
143, 144', never fatal, 145; 
tripod theory of, 149, 150; 
history of, 150 ff.; treatment 
of, 154 ff.; antitoxin of, 155, 
156; allied to asthma, 157; 141. 

Headaches, in sea-sickness, 255. 

Healing, art of. See Therapeutics. 

Health, national department of, 
urgently needed, 29, 30. 

Hearing, loss of. See Deafness. 

Heart, fat around the, 55, 56; 
violent exercise and the, 62; in- 
creasing death-rate from dis- 
ease of, 169; description and 
history of, 221, 222; varieties of, 
in different animals, 221, 222; 
valves of, 222, 223; valvular, 
or organic, disease of, 223 ff. ; 
hypertrophy of, 227 ff. ; mod- 
ern changes in treatment of 
diseases of, 228 ff.; restoring 
muscular power of, 229, 230; 
diseases of muscles of, 230, 231, 
232; insensitive to pain, 239, 
240; brown atrophy of, 240; 
fatty degeneration of, 241; 
functional disturbances of, 243; 
other diseases of, 244, 245. 

Heart failure, 220. 

Iftating, improved methods of, 
425, 426. 

Heller, Stephen, 364. 

Hemoglobin, 114. 

Hemorrhoids, 93. 

Hepatica, the, and liver diseases, 
8. 

Herbs. See Plants. 

Hindus, 411. 



INDEX 



445 



Hives, 147, 148. 

Holmes, O. W., 10, 219, 427. 

Hoof, of the horse, 290 /. 

Hookworm, incubation and jour- 
ney ings of, 317-321; a world- 
infection, 327. 

Hormones, 27. 

Hornets, 347. 

Horse, foot of the, 290 /.; has 
one toe, 325. 

Horse-shoe superstition, the, 10. 

Horse-shoes, 292 ff. 

House fly, the, 334, 335. 

"Household remedies," include 
the most dangerous drugs, 12, 
13. 

"Humors, the," 98. 

Hydatids, 117, 118. 

Hyoscyamus, discovery of, 6. 

Hypertrophy of the heart, 227/.; 
causes of, 230/.; 235 ff.; diet 
in, 233, 234. 

Hypochondria, 99. 

Hysteria, 379, 381. 

Illnesses, percentage of, that need 
no medicine, 11, 12. 

Imaginary diseases, not confined 
to leisure classes, 381; self- 
produced symptoms of, 384 ff. ; 
usually have some basis, 387, 
388, 392, 393; equally preva- 
lent in both sexes, 401. 

Imagination, the, cannot create 
illness, 378, 379; its chief work 
in disease, 388; power of, will 
produce pain, etc., 392, 393, 
395/. 

Immunity from second attack of 
disease, cause of, 20; cannot be 
passed on to others, 20. 

Indigestion, and the stomach, 76; 
causes of, 79, 80; distinguished 
from dyspepsia, 80; the only 



sure cure for, 83; individual 
susceptibility to, 83, 84; one of 
the oldest maladies in history, 
85 ; is decreasing, 85 ; starva- 
tion no cure for, 86, 87; three 
great factors of, 87, 88. 

Infantile paralysis, results of 
study of, 21, 22. 

Infants, congenital heart-defect 
of, 244,, 245; ear- troubles of, 
278. 

Infectious diseases, and the heart, 
224, 225. 

Influenza. See Colds. 

Inhibition, power of, 188. 

Inoculation, 23, 24. 

Insanity, black decoctions and ni- 
trate of silver as cures for, 10. 

Insect pests, distributors, not 
sources, of infection, 335 ; water 
to breed in, indispensable for, 
336 /. ; how deprived of water, 
337/.; 331, 332, 333. And see 
Mosquitoes. 

Insects, most varieties of, harm- 
less, 347. 

Insomnia, usually a symptom of 
mental or physical disturb- 
ance, 350, 351, 361, 375; a 
paradox* 353; peculiarities of, 
354, 355; not so black as it's 
painted, 357; a modern mal- 
ady, 358; terrors of, 358; sel- 
dom harmful, 359, 361, 364; 
gravity of, depends on cause, 
360; a danger-signal, 361; 
power of self-exaggeration, 
361, 374; not becoming more 
prevalent, 365; mental treat- 
ment of, 365, 366; usually 
easily cured, SG(], 374; from 
over-fatigue, 367; from non- 
fatigue, 367, 369, and lack 
of air and exercise, 369, 370- 



446 



INDEX 



and an empty stomach, 370; 
remedies for, 370 ff. ; the rare 
serious cases of, 375; cause of, 
must be removed, 376. 

Insomniac, tendency of, to mag- 
nify his trouble, 361, 362, 374; 
morbid pride of, 364; his split 
consciousness, 365, 374; and 
mental -suggestion, 365, 366; 
chronic, 374. 

Instep, the, 300, 301. 

Internal ear, the, 269-271, 272. 

Intestine, large, Metchnikoff on 
germs in the, 431, 432, 433. 

Invalids, self-made, 398 jf.; crave 
sympathy, 399. 

Iron, its use in medicine, 10, 11; 
why first regarded as a tonic, 
10. 

Itis, meaning of the termination, 
223. 

James, William, 194. 

Jaundice, in acute infections, 109; 

114, 115, 116. 
*' Jimson weed," the, 6. 

Kidneys, a filtering apparatus, 
167 ff.; increasing death-rate 
from disease of, 169, 170; dam- 
aged, substitutes for, 171, 181; 
functions of, 172; symptoms of 
disease of, 172, 173; rupture of 
blood-vessels in, 182, 183. And 
see Bright's disease. 

Kipling, Rudyard, 38, 193, 435. 

Lactic acid, 432, 433. 

Larynx, the, irritation of, in 

catarrh, 128, 129; 136. 
Laudanum, 13. 
Laughing gas, early experiments 

with, 362, 363. 
Laxatives, history of, 36-39. 



Leather, as an antiseptic, 318. 

Lecithin, 49. 

Leg, the, and flat foot, 300; mus- 
cles of, 298, 301. 

Lettuce, 35. 

Leucocytes, 19. 

Life, nature of, 428, 429. 

Limburger cheese, 107. 

Lincoln, Abraham, 68. 

Liniments, 39, 40. 

Liver, the, functions of, 94 ff. ; a 
destroyer of toxins and poisons, 
95, 101; long misunderstood, 
95, 96; its part in the ancient 
"omens," 96, 98; changes in, in 
disease, 96, 97; and the mental 
state, 99, 100, 101; a digestive 
organ, 101, 102; a blood-filter, 
102; disturbances of, how 
caused, 103, 104, 107/.; alco- 
hol and, 105; conversion of 
poisons by, 105; in infectious 
diseases, 108-110; degenera- 
tion of, 108; enlargement of, 
110, 111; diseases of, caused by 
inorganic poisons, 112, 113; 
and jaundice, 114; and the 
tubercle bacillus, 117; abscess 
in, 117; animal parasites in, 
117, 118; cancer in, 118. 

Liver, East Indian, 103, 104. 

Liver fluke, the, 118. 

Liver spots, 113, 114. 

Liverwort, as a cure for liver ills, 
8. 

Lockjaw. See Tetanus. 

Louis XIV, 406. 

Lunar caustic. See Silver, nitrate 
of. 

Lymph, 98. 

Lymphatic humor, 98. 

Macrophages, 431, 432. 
Malaria, use of quinine in, 18; 



INDEX 



447 



insect-borne, 333, 334, 335; 
109, 112, 115, 117. 

Man, primitive, and the discov- 
ery of drugs, 4, 5; and disease, 
13, 14; the twentieth-century, 
88. 

Mandragora, 9, 10. 

Mandrake, 9, 10. 

Marvell, Andrew, 331. 

Mastoid abscess, 274. 

Mastoid cells, 274, 275, 277. 

Match-makers' catarrh, 125. 

Materia medica, how built up, 4. 

Maturity, increased immunity 
from disease in, 141 ff. 

Measles, 178, 224, 277^ 279. 

Meat, and Bright's disease, 180jf. 

Medical attendance, by the year, 
44, 45. 

Medical profession, the, its com- 
ing struggle with drugs, 12. 
And see Doctors. 

Medicine, domestic, 32, 33. 

Medicine chest, of the future, 
probable contents of, 27. 

Medicine man, doctor first ap- 
pears as, 7; his method of treat- 
ment, 13, 14. 

Medicines, spring, 35. 

Melancholy, meaning of word, 
99. 

Men, baldness more common 
among than among women, 
206; imaginary diseases of, 
401, 402; why they attract less 
sympathy, 403, 404. 

Mercury, one of the three drugs 
that may cure disease, 17, 18. 

Metchnikoff, filie, 431 ff. 

Middle ear, seat of most cases of 
deafness, 272; bursting of, not 
dangerous, 273, 274; thickening 
of, and its causes of, 275, 276, 
277; affected by various dis- 



eases, 277; and the Eustachian 
tubes, 281; disease of, seldom 
causes total deafness, 282, 283; 
and wax, 285, 286; 268, 269, 
271, 422. 

Milk, 433. 

Milk, sour, as a cure for old age, 
432. 

Miners' pneumonia, 109. 

Mitchell, S. Weir, his treatment 
for neurasthenia, 53. 

Moisture, and catarrh, 124. 

Monkeys, and inoculation, 22; 
and sea-sickness, 255. 

Monotony, and worry, 191, 192; 
deadliness of, 196, 197. 

Moon, the, and curative proper- 
ties of lunar caustic, 10, 11. 

Moore, Thomas, 357, 358. 

Morality, and old age, 418. 

Morphine, in asthma and hay 
fever, 154, 155. 

Mosquito bites, futility of meth- 
ods of prevention of, 343, 344; 
how treated, 344 ff. 

Mosquitoes, 331, 332, 334, 335, 
336, 339, 340. And see Ano- 
pheles, and Stegomyia. 

Mosquitoes, salt water, 341, 342. 

Mouth, genesis of the, 74. 

Mucous membrane, the, in 
catarrh, 128, 135, 137, 138, 
139; in asthma and hay fever, 
144; 275. 

Muscles, in] blood-vessels, 235, 
236. 

Muscles of the heart, 227 /.; 
causes of injury to, 230, 231, 
232, 233. 

Myocarditis, 231. 

Myxedema, 26. 

Naples, Bay of, 259. 

Narcotics, known to every na- 



448 



INDEX 



tion and tribe, 14, 15; how 
used, 15. 

Nasal catarrh, 122, 123, 128. 

Nasal speech, and catarrh, 119, 
121. 

Nature, as doctor, 15, 16; proper 
function of doctors, to assist, 
16. 

Nausea, causes of, 77, 78; deri- 
vation of word, 248; nature of, 
257. 

Necator Americanus. See Hook- 
worm. 

Nerve deafness, 272. 

Nerve fluid, 99, 100. 

Nervous humor, 98, 99. 

Nervous system, in kidney dis- 
ease, 172; increasing death- 
rate from diseases of, 169. 

Nervous troubles, nitrate of silver 
as remedy for, 10. 

Neuralgia, in sea-sickness, 255. 

Neurasthenia, Dr. Mitchell's 
treatment for, 53; 374. 

"Neurotic" disturbances, 142, 
143. 

"Neurotics," delusions of, 388 j/f. 

New England conscience, the, 
189. 

Newton, Sir Isaac, 331. 

Nietzsche, Friedrich W., 12. 

Nose, genesis of the, 74; in ca- 
tarrh, 122, 123, 125, 126; its 
action on the air, 126, 127, 128; 
deformities of, 134, 135; dis- 
eases of, in hay fever, 154; port 
of entry for infections, 279. 

Oatmeal, dyspeptics produced 
by, 66. 

Obesity, discussed, 46 ff.; com- 
monly a mark of health, 48, 54; 
relation between, and food, 51 ; 
natural increase of, with in- 



creasing years, 51, 52; advan- 
tages of, 53. And see Adi- 
pose. 

Oils in the home medicine chest, 
39, 40. 

Old age, and deafness, 266, 267, 
268, 408, 421, 422; and failing 
sight, 267, 268, 408, 420, 421; 
dread of, unnatural, 406, 407; 
disadvantages of, how avoided, 
407; causes of most "symp- 
toms" of, 407; children's dis- 
eases and, 407, 408; rheuma- 
tism in, caused by infections, 
409, 410; premature, caused 
by poverty, 410; postpone- 
ment of, 411; degree of happi- 
ness in, 412, 413; rate of mor- 
tality in, less than in infancy, 
413; most acute infections less 
likely to be fatal in, 413; in- 
crease of equilibrium in, 414; 
decline of powers and inclina- 
tions in, 414, 415, 416; reaction 
from operations in, 416; dis- 
eases generally milder in, 416, 
417; and youth, contrasted, 
419; results of modern science 
in respect to, 419 ff.; loss of 
teeth in, 421; exercise in, 423; 
physical changes in, gradual 
and painless, 423; effect of 
modern inventions, 424, 425; 
change of climate in, 426; char- 
acter of physical changes in, 
427; no definite beginning of, 
427, 428, 429; has gone out of 
fashion, 429; a paradox con- 
cerning, 430; recent investiga- 
tions of, 430/.; MetchnikofFs 
theory of, 431, 432; results of 
autopsies, 434. 

Old-age pensions, 435. 

Opium, discovery of, 5; date of 



INDEX 



449 



first use of, unknown, 7; older 
than bread, 11; 13, 14, 34. 

Optic nerve, in kidney disease, 
173; 267. 

Osier, William, 16. 

Ovarian extract, 27. 

Overdriving one's self, unwisdom 
of, 194, 195. 

Overstrain, in heart disease, 231, 
232, 233, 236, 237. 

Overwork, as cause of arterio- 
sclerosis, 184, 185; 424. 

Pain, nature of, 392; possibilities 

of self-deception as to, 394, 

395. 
"Pain-killers," 13. 
Paralysis, 241, 242. 
Paralysis, infantile. See Infantile 

paralysis. 
Pare, Ambroise, 100. 
Paregoric, 13. 
Patent- medicine men, and the 

imaginary invalid, 389, 390. 
Patent medicines, opium and 

alcohol the backbone of, 13. 
Peary, Robert E., 130, 131. 
Pellagra, 337. 
Pepsins, 89, 90. 
Peritonitis, 109. 
Perspiration, the best hypnotic, 

370. 
Petroleum, and insect pests, 337, 

339, 340, 343. 
Pharynx, the, irritation of, in 

catarrh, 128, 129. 
Physical deterioration, Royal 

Commission on, 407, 408. 
Picts, the, 301. 

Pills, original purpose of, 38, 39. 
Plants, herbs, etc., medicinal 

properties of, how discovered 

by primitive man, 5; how tested 

in later times, 7, 8; extraordin- 



ary character of healing prop- 
erties ascribed to, 8ff. 
Pneumonia, antitoxins of, 21 ; 15, 

109, 112, 224, 231, 277, 409, 

413, 417. 
Poisons, the liver a destroyer of, 

95, 101; converted into foods 

by the liver, 106. 
Policemen, and flat foot, 304. 
Pollen, antitoxin of, in hay fever, 

155, 156. 
Polypi, 134, 135, 154. 
Poor, the, imaginary diseases of, 

381, 382. 
Poppy, the, and the discovery of 

opium, 5. 
Poultices, discarded by modern 

science, 41, 42. 
Poverty, and premature old age, 

410, 434, 435. 
Prevention of disease, the object 

of medical treatment, 28, 29. 
Priest, the, origin of, 7. 
Printers' catarrh, 125. 
Progress, one of the greatest 

obstacles to, 11. 
Prussic acid, and the liver, 106. 
Ptomaine poisoning, cause of, 82. 
Pus, in cavity of ear-drum, 275. 
Pus infections, vaccines for, 25. 

Quack, the, and the imaginary 

invalid, 389, 390. 
Quakers, the, 18. 
Quassia, 17. 
Quick lunch, the, 90. 
Quinine, one of the three drugs 

that may cure disease, 17, 18; 

34. 

Ragweed, and hay fever, 150 ff. 
Raleigh, Sir Walter, 8. 
"Real" drugs, 17. 
Reed, Thomas B., 63. 



450 



INDEX 



"Referred" pain, 393, 394, 395. 

Remedies, fanciful connection 
between, and certain diseases, 
9; new, triumphs of, how 
"loaded," 12; new, submitted 
to rigorous tests, 27, 28. 

Renal disease. See Kidneys. 

Renan, Ernest, 422. 

Rest, lack of, as cause of dyspep- 
sia, 89, 90, 91; 191. 

Retina, the, 268. 

Rheumatism, and the heart, 224; 
in old age, 409, 423; almost 
always an infection, 409; 15, 
318. 

Ringworm, 212. 

Rockefeller Institute, 22. 

Romans, the, and flat foot, 302. 

Roots. See Plants. 

"Rubbing-in," 40. 

Sainte-Beuve, C. A., 323. 

Salvarsan (606), value of, in 
syphilis, 18. 

Sanguine humor, 98. 

Sauerkraut, 107. 

Savages, digestion of, 87. 

Scalp tonics, 214, 215. 

Scarlet fever, and deafness, 277; 
109, 178, 224, 279. 

Schoolroom, the, and flat foot, 
302, 303. 

Scots, the, 301. 

Scott, Sir Walter, 239, 416. 

Scurvy, 87. 

Sea-sickness, discussed, 246 ff.\ 
concerns the brain alone, 247; 
stomach a passive instrument 
in, 247, 248; real cause of, 249 
ff.\ immunity from, 253, 254; 
various symptoms of, 255, 256; 
produced by anticipation, 257, 
258; no cure for, 260 Jf.; possi- 
ble mitigations of, 262, 263; 71. 



Seeds. See Plants. 

Self-love, in illness, 378. 

Self-pity, 377. 

Semicircular canals. See Canals. 

"Senile" changes, premature, 
how caused, 410, 427. And see 
Old age. 

Septum, the, deflections of, 136, 
139, 154. 

Serpent, the, what it symbolizes 
to-day, 3. 

Shakespeare, William, 330. 

Shaman. See Medicine man. 

Shape, of leaves, etc, supposed 
significance of, 8, 9. 

Sheep, toes of, 325. 

Shingles, and the black cat, 9. 

Shoe. See Boot and Footwear. 

Sick headache, 374. 

Silver, nitrate of, as a remedy for 
insanity, etc., 10, 11. 

Simulium (gnat), 337. 

Sinuses, accessory, in catarrh, 
137, 139. 

Six hundred and six, one of the 
three drugs that may cure dis- 
ease, 17, 18. 

Skin, sensitiveness of the, 79; 
action of, on exposure to cold, 
how guarded against, 132-134. 

Sleep, as remedy for dyspepsia, 
91; effect of loss of, 350; nature 
of, 350, 351 /.; requisite 
amount of, varies, 350, 352; 
consciousness in, 353, 354, 
355; loss of, readily made up, 
359, 360; in old age, 415. And 
see Insomnia. 

Sleeping out-of-doors, 369, 370. 

Sleeping sickness, 333. 

Sleeplessness. See Insomnia. 

Sleep-producing drugs, 373. 

Slippers, 309. 

Smallpox, 21, 22, 23, 279. 



INDEX 



451 



Smell, sense of, importance of, 
83. 

Snake in the stomach, 38 ff. 

Soil, bacilli in the, 317/. 

Solomon, 422. 

"Soothing-sirups," 13. 

Sore throat, 128, 224, 275. 

Spiders, 347. 

Spirocheta of syphilis, 18. 

Spotted fever. See Cerebrospinal 
meningitis. 

Spring hunger, the, 35, 36. 

Standing, and flat foot, 303, 304. 

Starch, 48. 

Starvation, to reduce obesity, 64, 
65; no cure for indigestion, 86, 
87. 

Stegomyia (mosquito), 338, 339. 

Stevenson, R. L., 364. 

Stockings, 310, 311. 

Stockton, Frank R., 31. 

Stomach, the American, 70; seat 
of the soul, 70, 71; its history, 
72 ff.; made the brain, 75; 
actual disease of, very rare, 76; 
the "works" of the body, 76, 
77; its good-nature, 77; nausea 
explained, 78, 79; its sensitive- 
ness, 79; the twentieth-cen- 
tury, 88; generally not the seat 
of trouble in dyspepsia, 90; 
ulcers in, 93; gas on the, and 
heart disease, 240; has no pri- 
mary connection with sea- 
sickness, 247, 248; emptiness 
of, and insomnia, 370. 

Stomach-ache, misuse of the 
term, 79. 

Stomach tube, 17. 

Strychnine, discovery of, 6; 34. 

Suggestion, effect of, in insom- 
nia, 365, 366. 

Suprarenal body, 431. 

Surgical fever, 109, 317. 



Survival of fittest, 4. 

Sweating treatment, 34. 

Sydenham, Thomas, 229. 

Symptoms, often Nature's effort 
to throw off poison, 15, 16; 
self-produced, of imaginary 
diseases, 384 ff. 

Syphilis, use of mercury and 606 
in, 18; not communicable to 
animals, 21; germs of, discov- 
ered by experiments on mon- 
keys, 22; 184, 185. 

Tachycardia, 244. 

Tapeworms, rarity of, 384; 85, 86. 

Tapir, toes of the, 325. 

Tarantula, 347. 

Tea, 243. 

Teeth, loss of, in old age, 421. 

Telephone transmitter, the ear 
compared to, 271. 

Temperaments, the four, 98. 

Temperature, artificial raising of, 
386, 387. 

Terminal infections, 241. 

Tetanus, 317, 322, 323, 334. 

Therapeutics, progress in know- 
ledge of, how acquired, 4; an 
illustration of the survival of 
the fittest, 4; to be considered 
justly only from evolutionary 
standpoint, 4; gradually be- 
comes a profession, 7 ff. 

Thorn apple, 6. 

Thought, excess of, 187. 

Throat, the, port of entry for in- 
fections, 279. And see Sore 
throat. 

Thymus gland, 431. 

Thyroid gland, 26, 244, 431. 

Tobacco, 107, 243. 

Tobacco-poultice, 41. 

Toes, deformities of, 324 ff. 

Tomato, 36. 



452 



INDEX 



Tonics, gradually falling into dis- 
repute, 17; 89. 

Tonsillitis, 178, 409. 

Tonsils, the, 431. 

Toxins, destroyed by the liver, 
95, 101; 19, 20. 

"Trans valuation of values," 12. 

Travel, improvement in methods 
of, 424, 425. 

Trefoil, 8. 

Trousseau, Armand, 165. 

Tsetse fly, 333. 

Tubercle bacillus, in the liver, 
117. 

Tuberculosis, antitoxin of, curi- 
ous conditions surrounding, 21 ; 
diminishing death-rate from, 
169; of the liver, 117; 178, 184, 
185, 317, 334. 

Turbinated bodies, 127, 128, 135, 
139, 154. 

Typhoid fever, antitoxin of, 21; 
vaccine for, 23, 24; diminishing 
death-rate from, 169; 15, 109, 
112, 178, 184, 185, 224, 317, 
334, 409. 

Ulcers, in the stomach, 93. 
Uric acid, 182. 

Urine, yellow remedies for, 8; 
albumen in, 171, 176-178. 

Vaccination, 23, 24. 

Vaccine virus, 23. 

Vaccinia, 23. 

Vaccines for various diseases, 23- 

25. 
Valves of the heart, 222, 223, 224, 

226, 227, 228, 229, 231. 
Valvular disease of the heart, 

223 jf.; infection most frequent 

cause of, 224; treatment of, 

225. 
Vasomotor nerves, 144. 



Vegetable world, the, and the 
hunger of primitive man, 5. 

Venereal diseases, 409, 410. 

Vision, blurring of, in old age, 
267, 268, 408, 420, 421. 

Vomiting, "central," in sea- 
sickness, 247, 255. 

Walking, and fashionable foot- 
wear, 296, 297; the best exer- 
cise, 298. 

Waltzing mice, 250. 

Ward, Artemas, 336. 

Wasps, 347, 348. 

Waste, worry as, 192. 

Water, in life-processes, 126; in- 
dispensable for breeding of 
insect pests, 336, 337, 338. 

Wax, in external ear, 285, 286. 

Whooping cough, 224, 277. 

Wigs, etc., 203, 204, 210. 

Wilde, Oscar, 187. 

Wise Woman, the, 13, 14. 

Woman, oldest of priests of iEscu- 
lapius, 3; the earliest doctor, 4. 

Women, monotonous lives of, 
197, 198; less liable to baldness 
than men, 206, 207; footwear 
of, 298, 299; imaginary dis- 
eases of, 401, 402, 403, 404. 

Work, change of, 191. 

Worms, 348, 383, 384. 

Worry, oftener a symptom than 
a cause of trouble, 189; chem- 
istry of, 190; causes and effect 
of, 191-193; antiquity of, 196; 
only cure for, 198. 

Wright, Sir Almroth, 24. 

Yellow fever, 115, 335, 338, 339. 
Yellow fever mosquito, 338, 339. 
Yellowness of skin, cause of, 116. 
Youth, and old age, contrasted, 
419. 



3 47 7 



